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Should women aged 70–74 be invited to participate in screening mammography? A report on two Australian community juries
  1. Chris Degeling1,2,
  2. Alexandra Barratt2,3,
  3. Sanchia Aranda4,
  4. Robin Bell5,
  5. Jenny Doust6,
  6. Nehmat Houssami2,3,
  7. Jolyn Hersch2,3,
  8. Ruben Sakowsky7,
  9. Vikki Entwistle8,
  10. Stacy M Carter1,2
  1. 1Research for Social Change, University of Wollongong, Wollongong, New South Wales, Australia
  2. 2Wiser Healthcare, Sydney, Australia
  3. 3Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  4. 4The Cancer Council Australia, Sydney, New South Wales, Australia
  5. 5Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  6. 6Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
  7. 7Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
  8. 8Health Services Research Unit, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Chris Degeling; degeling{at}uow.edu.au

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 sociocultural 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.

  • health policy
  • public health
  • mammography screening
  • overdiagnosis
  • deliberative methods

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Footnotes

  • Contributors CD designed the study, ran data collection and analysis processes, and led the drafting and revision of the manuscript. He is the guarantor. AB designed the study, participated in data analyses and made significant contributions to the drafting and revision of the manuscript. SA and RB participated in data collection and contributed to and revised the drafted manuscript. JD, NH, JH and RS designed the study, participated in data collection and contributed to and revised the drafted manuscript. VE designed the study and contributed to and revised the drafted manuscript. SMC designed the study, ran data collection, contributed to data analysis, made significant contributions to the drafting and revision of the manuscript. We also acknowledge the contribution of the 34 women who took part in the community juries.

  • Funding This work was supported by a Centre of Research Excellence grant (#1104136) from the National Health and Medical Research Council of Australia.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was approved by the Human Research Ethics Committee at the University of Sydney.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no data available for sharing at this time.

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