Screening and Test Evaluation Program, School of Public Health, University of Sydney, NSW 2006, Australia.
BMJ. 2013 Jan 23;346:f158. doi: 10.1136/bmj.f158.
To elicit women's responses to information about the nature and extent of overdiagnosis in mammography screening (detecting disease that would not present clinically during the woman's lifetime) and explore how awareness of overdiagnosis might influence attitudes and intentions about screening.
Qualitative study using focus groups that included a presentation explaining overdiagnosis, incorporating different published estimates of its rate (1-10%, 30%, 50%) and information on the mortality benefit of screening, with guided group discussions
Sydney, Australia
Fifty women aged 40-79 years with no personal history of breast cancer and with varying levels of education and participation in screening.
Prior awareness of breast cancer overdiagnosis was minimal. Women generally reacted with surprise, but most came to understand the issue. Responses to overdiagnosis and the different estimates of its magnitude were diverse. The highest estimate (50%) made some women perceive a need for more careful personal decision making about screening. In contrast, the lower and intermediate estimates (1-10% and 30%) had limited impact on attitudes and intentions, with many women remaining committed to screening. For some women, the information raised concerns, not about whether to screen but whether to treat a screen detected cancer or consider alternative approaches (such as watchful waiting). Information preferences varied: many women considered it important to take overdiagnosis into account and make informed choices about whether to have screening, but many wanted to be encouraged to be screened.
Women from a range of socioeconomic backgrounds could comprehend the issue of overdiagnosis in mammography screening, and they generally valued information about it. Effects on screening intentions may depend heavily on the rate of overdiagnosis. Overdiagnosis will be new and counterintuitive for many people and may influence screening and treatment decisions in unintended ways, underscoring the need for careful communication.
了解女性对乳房 X 光筛查中过度诊断（检测在女性一生中不会出现临床症状的疾病）性质和程度相关信息的反应，并探讨对过度诊断的认识如何影响对筛查的态度和意向。
采用焦点小组的定性研究，包括介绍过度诊断的内容，同时纳入不同已发表的过度诊断发生率估计值（1%-10%、30%、50%）和有关筛查带来的死亡率获益的信息，并进行小组讨论。
澳大利亚悉尼
50 名年龄在 40-79 岁之间、无乳腺癌个人病史、受教育程度和筛查参与程度不同的女性。
大多数女性对乳腺癌过度诊断的认识微乎其微。尽管女性普遍感到惊讶，但大多数人最终都能理解这个问题。对过度诊断及其严重程度的不同估计值的反应各不相同。最高估计值（50%）使一些女性认为需要更谨慎地个人决策是否进行筛查。相比之下，较低和中等估计值（1%-10%和 30%）对态度和意向的影响有限，许多女性仍然支持筛查。对一些女性来说，信息引起了关注，不是是否要进行筛查，而是是否要治疗筛查发现的癌症或考虑其他方法（如静观其变）。信息偏好各不相同：许多女性认为考虑过度诊断并对是否进行筛查做出知情选择很重要，但许多人希望被鼓励进行筛查。
来自不同社会经济背景的女性能够理解乳房 X 光筛查中的过度诊断问题，她们普遍重视相关信息。对筛查意向的影响可能在很大程度上取决于过度诊断的发生率。过度诊断对许多人来说是新的和违反直觉的，可能会以意想不到的方式影响筛查和治疗决策，这凸显了谨慎沟通的必要性。
