Media messaging affects perceptions of breast cancer screening

Media messaging could impact women’s perceptions of breast cancer screening, according to research published September 22 in Patient Education and Counseling.

A team led by Hamdi Abdi from the University of Minnesota in Minneapolis found that anecdotal messaging often brought about pro-screening attitudes among surveyed women, while evidence-based messaging often drew negative emotions and anger, as well as questioning or skeptical responses.

“Clinicians should recognize the role of the media in potentially shaping women’s attitudes, beliefs, and intentions when it comes to breast cancer screening,” Abdi and co-authors wrote.

There is a lot of information available for women when it comes to breast cancer screening, so much so that some data clash with one another on screening recommendations. For example, the National Comprehensive Cancer Network released recommendations in 2022 that all average-risk women over the age of 40 receive annual mammograms. However, the U.S. Preventive Services Task Force in its 2023 updates recommended that women with average breast cancer risk start getting screened every two years beginning at age 40, a B-grade recommendation.

While decision aids and support tools aim to help women navigate their personal values and beliefs, the researchers suggested that media messaging shapes women’s beliefs and attitudes in this area “prior to ever engaging with a provider about the topic.”

For their study, Abdi and colleagues wanted to analyze women’s responses to short media vignettes about limiting cancer screening. They noted that the study was conducted in the context of USPSTF recommendations before 2023, when women were recommended to begin routine screening at 50 years of age. The team randomly assigned women to read three communication strategies within a hypothetical news article: one using evidence, one using descriptive norms, and the other using anecdotes. The group compared responses to those stemming from a fourth pro-screening message.

The researchers included a national sample of 983 women between the ages of 35 and 50. They identified three thematic categories from the women’s responses: emotions, behavioral intentions, and cognitions, attitudes, and beliefs.

The team found a significant difference in the women expressing breast cancer awareness thoughts. Women who read the pro-screening message expressed the theme of cognitions, attitudes, and beliefs the most at 16%.

The researchers also reported a significant difference in women expressing pro-screening attitudes. Women in the anecdote (32.5%), norms (26.9%), and evidence conditions (22.5%) raised pro-screening attitudes more than those in the pro-screening group (15.6%). The researchers suggested that this theme was a form of counterarguing the message to which they were exposed.

Other findings reported by the team included the following:

  • Women exposed to the anecdote messaging had the highest prevalence of disagreeing with the message at 8.9%.
  • More questions were raised in all three screening-limiting conditions at 10% or higher compared to the pro-screening message at 4.2%.
  • Women exposed to the evidence message indicated more skepticism at 6.3%.
  • Women in the norms cohort raised more comments about patient autonomy at 7.7%.

Finally, the researchers found that women with a history of mammograms showed more pro-screening attitudes and disagreed with the evidence message more often.

Attitudes and behaviors of women with, without mammogram history
  Without mammogram history With mammogram history p-value
Reporting intention to not get screened or delay screening 4.1% 1.8% 0.032
Showing mixed feelings about screening 5.7% 3.1% 0.045
Expressing pro-screening attitudes 19.2% 28.8% 0.001
Showing disagreement with messaging 2.3% 7.7% < 0.001

“Media communication of the scientific research surrounding overdiagnosis prompted particular skepticism, suggesting more work is needed about how to communicate about overdiagnosis as a particular scientific phenomenon,” the study authors wrote.

They also suggested that these findings could be important for topics beyond mammogram screening. However, they called for future studies to continue to investigate how the public responds to messages about the “de-implementation” of valued care.

The full study can be found here

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