• Rebekah H Nagler, Franklin Fowler Erika E, and Sarah E Gollust.
• *Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, MN †Department of Government, Wesleyan University, Middletown, CT ‡Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN.
• Med Care. 2017 Oct 1; 55 (10): 879-885.

BackgroundScientists, clinicians, and other experts aim to maximize the benefits of cancer screening while minimizing its harms. Chief among these harms are overdiagnosis and overtreatment. Although available data suggest that patient awareness of these harms is low, we know little about how patients respond to information about these phenomena.ObjectivesUsing the case of breast cancer screening, this study assesses women's awareness of and reactions to statements about overdiagnosis and overtreatment.MethodsWe draw on data from a 2016 population-based survey of US women aged 35-55 years that oversampled women of lower socioeconomic position (those living at or below 100% of federal poverty level) (N=429).ResultsResults showed that women's awareness of overdiagnosis (16.5%) and overtreatment (18.0%) was low, and women under age 40 were least likely to have heard about overdiagnosis. Most women did not evaluate statements about these harms positively: <1 in 4 agreed with and found statements about overdiagnosis and overtreatment to be believable, and even fewer evaluated them as strong arguments to consider in their own mammography decision making. Women with a recent mammogram history were particularly unconvinced by overdiagnosis and overtreatment arguments.ConclusionsA majority of women were unaware of 2 important harms of breast cancer screening: overdiagnosis and overtreatment. Most did not find statements about these harms to be believable and persuasive. Communication interventions, supported by evidence from health communication research, are necessary to improve patient understanding of screening's harms, promote informed decision making, and, in turn, ensure high-value care.

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