Continue or stop: A qualitative analysis of mammography screening decision for older womenedit
There is insufficient evidence to determine the benefits and harms of screening mammography for women aged 75 and older. Therefore, guidelines emphasize on shared decision-making. This study aimed to understand older women’s mammography screening decision, physician’s role in their decision, and their willingness to discontinue screening. Using stratified sampling based on age (70–74 vs. 75+), race/ethnicity (Non-Hispanic Blacks, Hispanics, Non-Hispanic Whites) and education (≤high school vs. >high school), fifty-six older women with no breast cancer history participated in semi-structured interviews to discuss their decision-making process and preferences for screening. Iterative, comparative thematic analyses revealed that the majority of the older women desired to continue screening. Women aged 75+ tended to discontinue, whereas those aged 70–74 tended to continue screening. Seventy-seven percent of the older women stated that their physician initiated the discussion regarding continuing/discontinuing screening, whereas 18% initiated the discussion, 1% were influenced by a relative and only 4% stated involvement in shared decision-making, describing the process as a ‘mutual thing between us’ or ‘both [of us].’ Most women followed their physician’s recommendations for screening. Nearly 80% of those continuing mammography had no personal desire to stop, even for those aged 75+ (38%). Some of the reasons why a continuer may discontinue mammography screening were health, physician recommendation, harms, evidence or beyond the age of 80. This study suggests a need for improved communication between physicians and older women regarding the benefits and harms associated with mammography screening.