Framing overdiagnosis in breast screening: a qualitative study with Australian experts

Area of Science:

• Medical research
• Public health
• Qualitative research

Background:

• Overdiagnosis in breast cancer screening is a complex issue.
• Expert perspectives on this topic vary significantly.

Purpose of the Study:

• To identify how experts frame the issue of overdiagnosis in breast cancer screening.
• To analyze differences and similarities in expert frames regarding problems, causes, values, and solutions.

Main Methods:

• Qualitative methodology using interviews with 33 breast screening experts in Australia.
• Application of framing theory to analyze expert views on overdiagnosis.
• Inclusion of experts from diverse roles influencing public and policy.

Main Results:

• Six distinct frames for conceptualizing breast cancer overdiagnosis were identified.
• Frames include 'Overdiagnosis is harming women,' 'Stop squabbling in public,' 'Don't hide the problem from women,' 'We need to know the overdiagnosis rate,' 'Balancing harms and benefits is a personal matter,' and 'The problem is overtreatment.'
• Each frame presents a coherent view of the problem, causes, solutions, and moral evaluation, with some frames being commensurable and others incommensurable.

Conclusions:

• Expert framing of breast cancer overdiagnosis is highly varied.
• This variation in framing may fuel ongoing controversy surrounding the topic.
• Recognizing different expert frames can aid in navigating complex disagreements and informing screening decisions.