The effect of conflicting versus consistent messaging on older women's support for breast cancer screening cessation

Objective: Breast cancer over-screening is common in older women. Messaging about breast cancer screening cessation may reduce over-screening but the broader informational environment often emphasizes screening continuation. We aimed to examine the effect of receiving consistent messages about breast cancer screening cessation versus conflicting messages (i.e., receiving messages about screening cessation and screening continuation from different sources). Methods: In a two-wave survey experiment with 3809 women 65 + years from a U.S. population-based online panel, we randomized participants to a) no messages, b) consistent messages promoting screening cessation, or c) conflicting messages – a message promoting screening continuation followed by a message promoting screening cessation. Results: The conflicting message group had significantly lower support for screening cessation in a hypothetical older woman (mean 3.87 [SD 2.00] on 7-point scale, 95 % CI 3.76–3.97) compared with the consistent message group (mean 4.17 [SD 1.99], 95 % CI 4.08–4.28), but was still significantly higher than the control group (mean 2.68 [SD 1.87], 95 % CI 2.54–2.82, p's < 0.001). Message effects on self-screening intentions were similar. Participants reported low rates of confusion, distrust or ambivalence. Conclusions: Messaging about screening cessation can significantly increase older women's support for screening cessation, with low rates of negative reactions, even if there are competing messages on continued screening. Practice implications: Messaging about screening cessation can be incorporated into clinical discussions or used in conjunction with other interventions aimed at reducing over-screening.