Breast Cancer Screening Decisions for Women in Their 40s
Can we do a better job communicating about mammography screening to women who are newly eligible for it, and what would better communication look like?
What do we know already?
Most women have heard that mammography screening saves lives. Yet screening also introduces the risk of negative outcomes, such as false positives leading to unnecessary biopsies, and overdiagnosis (which is the discovery and treatment of early-stage cancers that will never grow or cause symptoms). For this reason, recommendations about when and how frequently to screen differ across expert groups. The U.S. Preventive Services Task Force encourages all women to become informed and to engage in a shared decision with their doctor when creating a screening plan.
The trouble with informing women of the evidence is that many react with skepticism, expressing disbelief and often distrust in the motivations behind the communication. Many wonder whether the message is meant to encourage healthcare rationing at the expense of their personal health. This is a problem, because communicating the evidence could unintentionally reduce trust rather than inform and empower.
What have we found so far?
Skepticism comes from conflicting messages, not from unwelcome ones. Many women are skeptical of evidence about mammography screening, particularly evidence about overdiagnosis. We examined whether that skepticism arises because information about the downsides of screening is an unwelcome message, or because it conflicts with messages women have previously heard. We found strong support for the latter explanation and only weak support for the former — which highlights the importance of consistent evidence-based screening messages across sources.
Exposure to screening evidence can reduce trust in the healthcare system. The people who lose the most trust tend to be people who perceive that the information conflicts with other screening messages. Again, this points to the importance of message consistency.
Wanting to screen less is not the same as not wanting screening. Some women want to delay regular mammograms once they become informed. But a desire to wait does not mean they never want screening; they want to wait until the balance of benefits and downsides looks more favorable. This was especially true for women at lower breast cancer risk and those concerned about false positives and overdiagnosis.
Women want to be informed even when they are skeptical. Although many women doubt the evidence, the majority still want to receive it. In focus groups, many said it would be unacceptable for information to be withheld.
What’s next?
In the final two years of this grant we are collecting data to identify what information women feel is critical to know before receiving screening, and how that information should be delivered. We will then develop an informational tool that provides this critical information and pilot test it. Our objective is to improve the consistency and quality of communication about mammography screening.
Funding
Funded by the National Cancer Institute, R37 CA254926.
Further Reading
In the media
Mammograms have pros and cons. Women can handle the nuance, study argues — NPR
Publications
Yoder G, Parmet T, McCaffery K, Hersch J, Schapira MM, Lewis CL, Cappella JN, Morse B, Tate C, Scherer LD. (2026). Women's attitudes toward the 2024 US Preventive Services Task Force mammography screening guideline. Medical Decision Making.
Parmet T, Yoder G, McCaffery K, Hersch J, Schapira MM, Lewis CL, Cappella JN, Morse B, Scherer LD. (2026). Women's screening preferences shift after being informed about the 2024 USPSTF mammography guideline. Patient Education and Counseling.
Scherer LD, Lewis CL, Cappella JN, McCaffery K, Hersch J, Morse B, Tate C, Parmet T, Mosley B, Smyth HL, Schapira MM. (2026). Laypeople's perceptions of clinician performance metrics based on cancer screening attendance. JAMA Health Forum.
Parmet T, Li Y, Cappella J, Scherer LD, Waters EA, Housten AJ. (2026). Reporting on the 2024 USPSTF mammography guideline update: a content analysis of trusted media sources. JAMA Network Open.
Morse B, Parmet T, Yoder G, Lewis C, McCaffery K, Cappella J, Hersch J, Tate CE, Schapira MM, Scherer LD. (2025). Evaluation of how US women react to a decision aid informing them of the harms and benefits of mammography: a qualitative study. BMJ Open.
Parmet T, Yoder G, Morse B, Cappella J, Schapira M, Lewis C, McCaffery K, Smyth H, Hersch J, Scherer LD. (2025). Trust in the healthcare system declines after exposure to information about the harms and benefits of breast cancer screening. Journal of Health Psychology.
Scherer LD, Lewis CL, Cappella JN, Hersch J, McCaffery K, Tate C, Smyth HL, Mosley B, Morse B, Schapira MM. (2025). Skeptical reactions to breast cancer screening benefits and harms: antecedents, consequences, and implications for screening communication. Health Psychology.
Scherer LD, Lewis CL, McCaffery K, Hersch J, Cappella JN, Tate C, Morse B, Arnett K, Mosley B, Smyth HL, Schapira MM. (2024). Mammography screening preferences among screening-eligible women in their 40s: a national U.S. survey. Annals of Internal Medicine.
Scherer LD, Suresh K, Lewis CL, McCaffery K, Hersch J, Cappella JN, Morse B, Tate CE, Mosley BS, Schmiege S, Schapira MM. (2023). Assessing and understanding reactance, self-exemption, disbelief and source derogation in reaction to overdiagnosis in mammography screening: scale development and preliminary validation. Medical Decision Making.