Women's Awareness of and Responses to Messages about Breast Cancer Overdiagnosis and Overtreatment

Rebekah H. Nagler, Erika Franklin Fowler, Sarah E. Gollust

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Background: Scientists, clinicians, and other experts aim to maximize the benefits of cancer screening while minimizing its harms. Chief among these harms are overdiagnosis and overtreatment. Although available data suggest that patient awareness of these harms is low, we know little about how patients respond to information about these phenomena. Objectives: Using the case of breast cancer screening, this study assesses women's awareness of and reactions to statements about overdiagnosis and overtreatment. Methods: We draw on data from a 2016 population-based survey of US women aged 35-55 years that oversampled women of lower socioeconomic position (those living at or below 100% of federal poverty level) (N=429). Results: Results showed that women's awareness of overdiagnosis (16.5%) and overtreatment (18.0%) was low, and women under age 40 were least likely to have heard about overdiagnosis. Most women did not evaluate statements about these harms positively: <1 in 4 agreed with and found statements about overdiagnosis and overtreatment to be believable, and even fewer evaluated them as strong arguments to consider in their own mammography decision making. Women with a recent mammogram history were particularly unconvinced by overdiagnosis and overtreatment arguments. Conclusions: A majority of women were unaware of 2 important harms of breast cancer screening: overdiagnosis and overtreatment. Most did not find statements about these harms to be believable and persuasive. Communication interventions, supported by evidence from health communication research, are necessary to improve patient understanding of screening's harms, promote informed decision making, and, in turn, ensure high-value care.

Original languageEnglish (US)
Pages (from-to)879-885
Number of pages7
JournalMedical care
Issue number10
StatePublished - 2017

Bibliographical note

Funding Information:
Supported in part by an American Cancer Society Research Scholar Grant (RSG-14-166-01-CPPB). R.H.N. acknowledges support from the Build-ing Interdisciplinary Research Careers in Women’s Health Grant (K12-HD055887) from the Eunice Kennedy Shriver National Institutes of Child Health and Human Development, the Office of Research on Women’s Health, and the National Institute on Aging, administered by the University of Minnesota Deborah E. Powell Center for Women’s Health. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc. All rights reserved.


  • breast cancer
  • health communication
  • mammography screening
  • overdiagnosis
  • overtreatment


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