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[Preprint]. 2025 Feb 3:2025.01.30.25321380.
doi: 10.1101/2025.01.30.25321380.

Understanding motivations of older women to continue or discontinue breast cancer screening

Susan C Weller  1   2   3 , Monique R Pappadis  1   3   4 , Shilpa Krishnan  5 , Marsja R Stearnes  3 , Kristin M Sheffield  3   6   7 , Alai Tan  8 , Jeffrey Z Qi  9 , James S Goodwin  3   10
Affiliations

Understanding motivations of older women to continue or discontinue breast cancer screening

Susan C Weller et al. medRxiv. .

Update in

Abstract

Background: Breast cancer screening guidelines indicate screening in women over 75 years of age is optional, depending upon patient health and preferences.

Objectives: To link experiences and perceptions of older women concerning screening to their intention to continue or discontinue screening.

Design: Qualitative comparative study, comparing continuers and discontinuers.

Setting: Community-residing adults.

Participants: A purposive sample (n=59) with equal representation of White, Black, and Hispanic women by age (70-74 years and 75 and older) and educational level (≤12 grade and >12 grade).

Measurements: In-depth qualitative interviews explored women's perceptions of mammograms, the benefits and risks of screening, and personal screening experiences. Interviews were coded and quality-checked by two or more coders. A qualitative comparative analysis (QCA) was used to identify combinations of personal characteristics and themes linked to the intention to continue (n=32) or discontinue (n=27) screening.

Results: Personal experience themes were strongly linked to the intention to continue or discontinue. Women who mentioned recent screening (within three years) and either a spontaneously mentioned cancer story concerning a friend or family member or a doctor's screening recommendation intended to continue screening (91% true positive rate, model sensitivity). Women who did not schedule screening and who did not mention a cancer story or a doctor's recommendation (or neither) intended to discontinue screening (81% true negative rate, model specificity). These themes transcended differences in race/ethnicity, age, and educational level.

Conclusion: Continuation of breast cancer screening in older women is motivated by their personal screening history combined with cancer experiences and/or a doctor's screening recommendation.

Keywords: Mammography; breast cancer screening; geriatrics; older women; qualitative comparative analysis.

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References

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