NEW YORK (Reuters Health) - A decision aid that discusses both the pros and cons of continuing mammographic screening may help older women make the best informed choice, according to a report in the Archives of Internal Medicine.
While mammographic screening can reduce mortality from breast cancer, in older women it can lead to over-treatment for malignancies and unnecessary imaging tests and biopsies for benign disease. Most guidelines support its use in women between 50 and 69 years of age, but whether the benefits outweigh the harms in older women is unclear.
In their study, Dr. Alexandra Barratt and colleagues, from the University of Sydney in Australia, designed a nine-item questionnaire to assess whether older women given a decision aid or a booklet made an informed choice about continuing or stopping mammographic screening.
The study included 367 women who were assigned to receive the decision aid, which provided evidence-based, quantitative information about screening outcomes, and 367 who were given a standard information booklet.
The subjects given the decision aid showed a significantly greater improvement in screening knowledge compared with the women given the booklets. In addition, the percentage of subjects making an informed choice was higher in the decision aid group, at 73.5 percent vs. 48.8 percent.
The use of the decision aid did not increase anxiety and may have decreased conflict about the decision, the report indicates. No significant difference in the percentage of women who subsequently underwent screening was seen between the groups.
"This study has demonstrated that a decision aid about mammography screening increased knowledge and enabled more women to make an informed choice about screening," the authors conclude.
In a related editorial, Dr. Louise C. Walter and Dr. Carmen L. Lewis, from the VA Medical Center in San Francisco, comment that "decision aids are a promising tool to promote informed decision making."
However, many questions are still unanswered about the optimal way the information should be presented and exactly how the decision aid should be integrated into medical practice.
SOURCE: Archives of Internal Medicine, October 22, 2007.
