Women's screening preferences shift after being informed about the 2024 USPSTF breast cancer screening guideline

Abstract

Introduction: In 2024 the United States Preventive Services Task Force (USPSTF) revised its breast cancer screening (BCS) guidelines to recommend that all women screen biennially from age 40-74, replacing its prior recommendation that women ages 40-49 engage in informed decision-making about when to begin BCS. We examined how communicating information about the new guideline influenced women's screening preferences and views on what information women should receive before screening.

Methods: This study included 301 women who were previously enrolled in a longitudinal study where they were exposed to a decision aid informing them about BCS harms and benefits and the prior USPSTF recommendation. Participants completed an online survey including an informational intervention that presented information about the 2024 USPSTF recommendation. Outcomes included screening preferences pre- and post-intervention and ratings (1 =not at all important to 4 =very important) of information considered important to know before screening.

Results: Information about the new guideline influenced participants' screening preferences. Post-intervention, compared with pre-intervention, participants preferred to screen at their current age (86% vs 81%; p < 0.001) and biennially thereafter (45% vs 33%; p < 0.001). Participants believed it was important for women to be informed about the benefits of screening (M=3.77), their personal risk of breast cancer (M=3.75), and about overdiagnosis (M=3.48) and false positives (M=3.61).

Conclusions: Being informed about the 2024 USPSTF mammography guidelines shifted screening preferences to be consistent with the new guideline. Even though the new guideline deemphasizes informed decision-making, women still wanted to be informed about BCS harms and benefits, as well as their personal cancer risk.

Practice implications: Clinicians and health systems may consider pairing clear and directive information about the new BCS guidelines with brief information about BCS benefits and harms and personal risk, to support guideline-concordant and informed screening decisions.

Keywords: Breast cancer screening; Decision aids; Health communication; Patient education; Shared decision-making.