12-month follow-up effects of overdetection information in ... · sydney medical school 12-month...
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SYDNEY MEDICAL SCHOOL
12-MONTH FOLLOW-UP EFFECTS OF
OVERDETECTION INFORMATION IN A
BREAST SCREENING DECISION AID TRIAL
Jolyn Hersch, Alexandra Barratt, Jesse Jansen, Gemma Jacklyn, Kevin McGeechan, Les Irwig,
Hazel Thornton, Haryana Dhillon, Nehmat Houssami, Kirsten McCaffery
Sydney School of Public Health
@jolynhersch
OVERDETECTION / OVERDIAGNOSIS
› Screening early diagnosis + treatment
reduce breast cancer deaths
› Overdiagnosis / overdetection
- Finding disease that would not present clinically in lifetime
- Leads to overtreatment
› What is the risk of overdetection through regular screening?
- Estimates vary
- 30% of breast cancers diagnosed in regularly screened women, during the active screening period (Jacklyn et al. 2016)
Image from guardian.co.uk
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RATIONALE FOR STUDY
› Breast screening can lead to overdetection / overdiagnosis
and overtreatment of inconsequential breast cancers
- Harm to physical and emotional health in short and long term
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› “Information should be made available in a
transparent and objective way to women
invited to screening so that they can make
informed decisions” - Independent UK Panel
› Need to investigate the effects of giving
women information about overdetection
STUDY QUESTION & OUTCOMES
› What are the consequences of providing
written info about overdetection of breast cancer
to women approaching the age of invitation to screening?
- Primary outcome: informed choice about screening
- Other outcomes: knowledge, attitudes, intentions,
psychosocial wellbeing (anxiety, worry), risk perceptions,
screening participation
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DESIGN & PARTICIPANT FLOW
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Qualitative stream (n = 63)
Intervention DA (n = 440): benefit + overdetection +
false positives
Telephone survey (n = 838)
Primary outcome = informed choice
Secondary outcomes
Quantitative stream (n = 879)
R
Telephone survey: Baseline measures (n = 942)
Send BreastScreen NSW leaflet
FOLLOW-UP @
3 weeks
BASELINE
R
Women aged 48-50 years
Control DA (n = 439): benefit +
false positives only
Send decision aid (DA) booklet
RECRUITMENT
Mail-out #2
Mail-out #1
Telephone surveys (n = 790; n = 746)
Secondary outcomes FOLLOW-UP @
6 & 12 months
METHODS
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DESIGN & PARTICIPANT FLOW
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Qualitative stream (n = 63)
Intervention DA (n = 440): benefit + overdetection +
false positives
Telephone survey (n = 838)
Primary outcome = informed choice
Secondary outcomes
Quantitative stream (n = 879)
R
Telephone survey: Baseline measures (n = 942)
Send BreastScreen NSW leaflet
FOLLOW-UP @
3 weeks
BASELINE
R
Women aged 48-50 years
Control DA (n = 439): benefit +
false positives only
Send decision aid (DA) booklet
RECRUITMENT
Mail-out #2
Mail-out #1
Telephone surveys (n = 790; n = 746)
Secondary outcomes FOLLOW-UP @
6 & 12 months
SUMMARY OF INITIAL FINDINGS
Compared with the control DA, the intervention resulted in
› improved knowledge about breast screening
› less positive attitudes towards having breast screening
› reduced intentions to have breast screening in next 2-3 years
› more women making an informed choice
› lower worry about breast cancer
› no differences in anxiety or perceived risk of breast cancer.
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DESIGN & PARTICIPANT FLOW
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Qualitative stream (n = 63)
Intervention DA (n = 440): benefit + overdetection +
false positives
Telephone survey (n = 838)
Primary outcome = informed choice
Secondary outcomes
Quantitative stream (n = 879)
R
Telephone survey: Baseline measures (n = 942)
Send BreastScreen NSW leaflet
FOLLOW-UP @
3 weeks
BASELINE
R
Women aged 48-50 years
Control DA (n = 439): benefit +
false positives only
Send decision aid (DA) booklet
RECRUITMENT
Mail-out #2
Mail-out #1
Telephone surveys (n = 790; n = 746)
Secondary outcomes FOLLOW-UP @
6 & 12 months
KNOWLEDGE & ATTITUDES, 12m
Outcome Intervention
Group
Control
Group
P value
Adequate conceptual
knowledge 40% 20% <.01
Positive attitudes
towards screening 77% 85% <.01
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ANXIETY & PERCEIVED RISK, 6m
Outcome Intervention
Group
Control
Group
P value
Anxiety (STAI-short) 32.5 32.7 .8
Perceived risk (absolute)
No chance
Low chance
Medium / high chance
04%
64%
32%
04%
57%
39%
.1
Perceived risk (relative)
Much / a bit lower
About the same
A bit / much higher
32%
61%
07%
29%
62%
10%
.4
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ANXIETY & PERCEIVED RISK, 12m
Outcome Intervention
Group
Control
Group
P value
Anxiety (STAI-short) 31.7 32.2 .6
Perceived risk (absolute)
No chance
Low chance
Medium / high chance
03%
63%
35%
04%
59%
38%
.5
Perceived risk (relative)
Much / a bit lower
About the same
A bit / much higher
38%
53%
10%
31%
60%
09%
.1
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BREAST CANCER WORRY, 6 & 12m
Outcome Intervention
Group
Control
Group
P value
6m – Breast cancer worry
Not worried at all
A bit worried
Quite worried
Very worried
45%
51%
04%
01%
38%
55%
06%
02%
.05
12m – Breast cancer worry
Not worried at all
A bit worried
Quite worried
Very worried
47%
49%
04%
01%
39%
55%
05%
02%
.07
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MAMMOGRAPHY, 6m
14
0%
5%
10%
15%
20%
25%
30%
35%
Intervention Control
6 months
MAMMOGRAPHY, 12m
15
0%
5%
10%
15%
20%
25%
30%
35%
Intervention Control
12 months
6 months
SUMMARY & NEXT STEPS
› Including information about overdetection in a decision aid
› improved conceptual knowledge and shifted attitudes
› did not raise anxiety; lowered breast cancer worry
- These effects persisted 12 months post-intervention
› Although screening intentions differed between study groups,
self-reported screening uptake did not differ after 12 months
› Final, 2-year follow-up round just completed, including both
self-reported and objectively recorded screening participation
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ACKNOWLEDGEMENTS
› Kirsten McCaffery, Jesse Jansen, Alexandra Barratt, Les Irwig
› Kevin McGeechan, Gemma Jacklyn, Nehmat Houssami
› Haryana Dhillon, Hazel Thornton, Jenn Kidd
National Health and Medical Research Council
Screening and Test Evaluation Program
@jolynhersch
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