Should women aged 70-74 be invited to participate in screening mammography? A report on two Australian community juries

Chris Degeling, Alexandra Barratt, Sanchia Aranda, Robin Bell, Jenny Doust, Nehmat Houssami, Jolyn Hersch, Ruben Andreas Sakowsky, Vikki Ann Entwistle, Stacy Carter

Research output: Contribution to journalArticle

2 Citations (Scopus)
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Abstract

Abstract
Objective To elicit informed views from Australian women aged 70–74 regarding the acceptability of ceasing to invite women their age to participate in government-funded mammography screening (BreastScreen).
Design Two community juries held in 2017.
Setting Greater Sydney, a metropolis of 4.5 million people
in New South Wales, Australia.
Participants 34 women aged 70–74 with no personal history of breast cancer, recruited by random digit dialling and previously randomly recruited list-based
samples.
Main outcomes and measures Jury verdict and rationale in response to structured questions. We transcribed audio recorded jury proceedings and identified central reasons for the jury’s decision.
Results The women’s average age was 71.5 years. Participants were of diverse socio cultural backgrounds, with the sample designed to include women of lower
levels of educational attainment. Both juries concluded by majority verdict (16–2 and 10–6) that BreastScreen should continue to send invitations and promote screening to their age group. Reasons given for the majority position include: (1) sending the invitations shows that society still cares about older women, empowers them to access preventive health services and recognises increasing and varied life expectancy; (2) screening provides women with information that enables choice and (3) if experts cannot agree, the conservative approach is to maintain the status quo until the evidence is clear. Reasons for the minority position were the potential for harms through overdiagnosis and misallocation of scarce health resources.
Conclusions Preventive programmes such as mammography screening are likely to have significant symbolic value once they are socially embedded. Arguments for programme de-implementation emphasising declining benefit because of limited life expectancy and the risks of overdiagnosis seem unlikely to resonate with healthy older women. In situations where there is no consensus among experts on the value of established screening programmes, people may strongly
prefer receiving information about their health and having the opportunity make their own choices
Original languageEnglish
Article numbere021174
Number of pages9
JournalBMJ Open
Volume8
Issue number6
Early online date14 Jun 2018
DOIs
Publication statusPublished - Jun 2018

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Mammography
Preventive Health Services
Life Expectancy
South Australia
New South Wales
Health Resources
Age Groups
Outcome Assessment (Health Care)
Breast Neoplasms
Health

Cite this

Degeling, C., Barratt, A., Aranda, S., Bell, R., Doust, J., Houssami, N., ... Carter, S. (2018). Should women aged 70-74 be invited to participate in screening mammography? A report on two Australian community juries. BMJ Open, 8(6), [e021174]. https://doi.org/10.1136/bmjopen-2017-021174

Should women aged 70-74 be invited to participate in screening mammography? A report on two Australian community juries. / Degeling, Chris; Barratt, Alexandra; Aranda, Sanchia; Bell, Robin; Doust, Jenny; Houssami, Nehmat; Hersch, Jolyn; Sakowsky, Ruben Andreas; Entwistle, Vikki Ann; Carter, Stacy.

In: BMJ Open, Vol. 8, No. 6, e021174, 06.2018.

Research output: Contribution to journalArticle

Degeling, C, Barratt, A, Aranda, S, Bell, R, Doust, J, Houssami, N, Hersch, J, Sakowsky, RA, Entwistle, VA & Carter, S 2018, 'Should women aged 70-74 be invited to participate in screening mammography? A report on two Australian community juries' BMJ Open, vol. 8, no. 6, e021174. https://doi.org/10.1136/bmjopen-2017-021174
Degeling, Chris ; Barratt, Alexandra ; Aranda, Sanchia ; Bell, Robin ; Doust, Jenny ; Houssami, Nehmat ; Hersch, Jolyn ; Sakowsky, Ruben Andreas ; Entwistle, Vikki Ann ; Carter, Stacy. / Should women aged 70-74 be invited to participate in screening mammography? A report on two Australian community juries. In: BMJ Open. 2018 ; Vol. 8, No. 6.
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abstract = "AbstractObjective To elicit informed views from Australian women aged 70–74 regarding the acceptability of ceasing to invite women their age to participate in government-funded mammography screening (BreastScreen).Design Two community juries held in 2017. Setting Greater Sydney, a metropolis of 4.5 million peoplein New South Wales, Australia.Participants 34 women aged 70–74 with no personal history of breast cancer, recruited by random digit dialling and previously randomly recruited list-basedsamples.Main outcomes and measures Jury verdict and rationale in response to structured questions. We transcribed audio recorded jury proceedings and identified central reasons for the jury’s decision.Results The women’s average age was 71.5 years. Participants were of diverse socio cultural backgrounds, with the sample designed to include women of lowerlevels of educational attainment. Both juries concluded by majority verdict (16–2 and 10–6) that BreastScreen should continue to send invitations and promote screening to their age group. Reasons given for the majority position include: (1) sending the invitations shows that society still cares about older women, empowers them to access preventive health services and recognises increasing and varied life expectancy; (2) screening provides women with information that enables choice and (3) if experts cannot agree, the conservative approach is to maintain the status quo until the evidence is clear. Reasons for the minority position were the potential for harms through overdiagnosis and misallocation of scarce health resources.Conclusions Preventive programmes such as mammography screening are likely to have significant symbolic value once they are socially embedded. Arguments for programme de-implementation emphasising declining benefit because of limited life expectancy and the risks of overdiagnosis seem unlikely to resonate with healthy older women. In situations where there is no consensus among experts on the value of established screening programmes, people may stronglyprefer receiving information about their health and having the opportunity make their own choices",
author = "Chris Degeling and Alexandra Barratt and Sanchia Aranda and Robin Bell and Jenny Doust and Nehmat Houssami and Jolyn Hersch and Sakowsky, {Ruben Andreas} and Entwistle, {Vikki Ann} and Stacy Carter",
note = "Acknowledgments We acknowledge the contribution of the 34 women who took part in the community juries, and our colleagues Les Irwig, Jesse Jansen and Gemma Jacklyn who provided feedback on the composition of the ‘charge’ or question central to jury processes.",
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T2 - A report on two Australian community juries

AU - Degeling, Chris

AU - Barratt, Alexandra

AU - Aranda, Sanchia

AU - Bell, Robin

AU - Doust, Jenny

AU - Houssami, Nehmat

AU - Hersch, Jolyn

AU - Sakowsky, Ruben Andreas

AU - Entwistle, Vikki Ann

AU - Carter, Stacy

N1 - Acknowledgments We acknowledge the contribution of the 34 women who took part in the community juries, and our colleagues Les Irwig, Jesse Jansen and Gemma Jacklyn who provided feedback on the composition of the ‘charge’ or question central to jury processes.

PY - 2018/6

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N2 - AbstractObjective To elicit informed views from Australian women aged 70–74 regarding the acceptability of ceasing to invite women their age to participate in government-funded mammography screening (BreastScreen).Design Two community juries held in 2017. Setting Greater Sydney, a metropolis of 4.5 million peoplein New South Wales, Australia.Participants 34 women aged 70–74 with no personal history of breast cancer, recruited by random digit dialling and previously randomly recruited list-basedsamples.Main outcomes and measures Jury verdict and rationale in response to structured questions. We transcribed audio recorded jury proceedings and identified central reasons for the jury’s decision.Results The women’s average age was 71.5 years. Participants were of diverse socio cultural backgrounds, with the sample designed to include women of lowerlevels of educational attainment. Both juries concluded by majority verdict (16–2 and 10–6) that BreastScreen should continue to send invitations and promote screening to their age group. Reasons given for the majority position include: (1) sending the invitations shows that society still cares about older women, empowers them to access preventive health services and recognises increasing and varied life expectancy; (2) screening provides women with information that enables choice and (3) if experts cannot agree, the conservative approach is to maintain the status quo until the evidence is clear. Reasons for the minority position were the potential for harms through overdiagnosis and misallocation of scarce health resources.Conclusions Preventive programmes such as mammography screening are likely to have significant symbolic value once they are socially embedded. Arguments for programme de-implementation emphasising declining benefit because of limited life expectancy and the risks of overdiagnosis seem unlikely to resonate with healthy older women. In situations where there is no consensus among experts on the value of established screening programmes, people may stronglyprefer receiving information about their health and having the opportunity make their own choices

AB - AbstractObjective To elicit informed views from Australian women aged 70–74 regarding the acceptability of ceasing to invite women their age to participate in government-funded mammography screening (BreastScreen).Design Two community juries held in 2017. Setting Greater Sydney, a metropolis of 4.5 million peoplein New South Wales, Australia.Participants 34 women aged 70–74 with no personal history of breast cancer, recruited by random digit dialling and previously randomly recruited list-basedsamples.Main outcomes and measures Jury verdict and rationale in response to structured questions. We transcribed audio recorded jury proceedings and identified central reasons for the jury’s decision.Results The women’s average age was 71.5 years. Participants were of diverse socio cultural backgrounds, with the sample designed to include women of lowerlevels of educational attainment. Both juries concluded by majority verdict (16–2 and 10–6) that BreastScreen should continue to send invitations and promote screening to their age group. Reasons given for the majority position include: (1) sending the invitations shows that society still cares about older women, empowers them to access preventive health services and recognises increasing and varied life expectancy; (2) screening provides women with information that enables choice and (3) if experts cannot agree, the conservative approach is to maintain the status quo until the evidence is clear. Reasons for the minority position were the potential for harms through overdiagnosis and misallocation of scarce health resources.Conclusions Preventive programmes such as mammography screening are likely to have significant symbolic value once they are socially embedded. Arguments for programme de-implementation emphasising declining benefit because of limited life expectancy and the risks of overdiagnosis seem unlikely to resonate with healthy older women. In situations where there is no consensus among experts on the value of established screening programmes, people may stronglyprefer receiving information about their health and having the opportunity make their own choices

U2 - 10.1136/bmjopen-2017-021174

DO - 10.1136/bmjopen-2017-021174

M3 - Article

VL - 8

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 6

M1 - e021174

ER -