Testing Theory-Based Messages to Encourage Women at Average Risk for Breast Cancer to Consider Biennial Mammography Screening

Abstract Background The US Preventive Services Task Force does not recommend routine annual mammography screening for women aged 40–49 at average risk. Little research has been done to develop theory-based communication interventions to facilitate informed decision-making about reducing potentially low-value mammography screening. Purpose Evaluate the effects of theory-based persuasive messages on women’s willingness to consider delaying screening mammography until age 50 or have mammograms biennially. Methods We conducted a randomized controlled communication experiment online with a population-based sample of U.S. women aged 40–49 (N = 383) who screened to be at average risk for breast cancer. Women were randomly assigned to the following messaging summaries: annual mammography risks in 40s (Arm 1, n = 124), mammography risks plus family history-based genetic risk (Arm 2, n = 120), and mammography risks, genetic risk, and behavioral alternatives (Arm 3, n = 139). Willingness to delay screening or reduce screening frequency was assessed post-experiment by a set of 5-point Likert scale items. Results Women in Arm 3 reported significantly greater willingness to delay screening mammography until age 50 (mean = 0.23, SD = 1.26) compared with those in Arm 1 (mean = −0.17, SD = 1.20; p = .04). There were no significant arm differences in willingness to reduce screening frequency. Exposure to the communication messages significantly shifted women’s breast cancer-related risk perceptions without increasing unwarranted cancer worry across all three arms. Conclusions Providing women with screening information and options may help initiate challenging discussions with providers about potentially low-value screening.