US women's attitudes to false-positive mammography results and detection of ductal carcinoma in situ: cross-sectional survey

Abstract

Objective: To determine women's attitudes and knowledge of both false-positive mammography results and the detection of ductal carcinoma in situ after screening mammography.

Design: Cross-sectional survey.

Setting: United States.

Participants: A total of 479 women aged 18 to 97 years who did not report a history of breast cancer. Main outcome measures Attitudes and knowledge about false-positive results and the detection of ductal carcinoma in situ after screening mammography.

Results: Women were aware that false-positive results do occur. Their median estimate of the false-positive rate for 10 years of annual screening was 20% (25th percentile estimate, 10%; 75th percentile estimate, 45%). The women were highly tolerant of false-positive results: 63% thought that 500 or more false-positives per life saved was reasonable, and 37% would tolerate a rate of 10,000 or more. Women who had had a false-positive result (n = 76) expressed the same high tolerance: 30 (39%) would tolerate 10,000 or more false-positives. In all, 62% of women did not want to take false-positive results into account when deciding about screening. Only 8% of women thought that mammography could harm a woman without breast cancer, and 94% doubted the possibility of nonprogressive breast cancers. Few had heard of ductal carcinoma in situ, a cancer that may not progress, but when informed, 60% of women wanted to take into account the possibility of it being detected when deciding about screening.

Conclusions: Women are aware of false-positive results and seem to view them as an acceptable consequence of screening mammography. In contrast, most women are unaware that screening can detect cancers that may never progress but think that such information would be relevant. Education should perhaps focus less on false-positive results and more on the less-familiar outcome of the detection of ductal carcinoma in situ.

Figure 1

Women's ranking of benefits of health-promoting activities and 10-year program of mammography for extending life in a 60-year-old woman. Arrows show median response for each strategy.

Figure 2

Number of false-positive results women were prepared to tolerate for each life saved

Figure 4

Mammography is vigorously promoted in the United States ^{© John Pineda/AP}

Figure 3

Women's threshold for treatment of ductal carcinoma in situ according to its chance of becoming invasive