Observing Skepticism Toward a Breast Cancer Screening Decision Aid Over Time

Prior research reported that some women are skeptical toward messages about mammography screening evidence, particularly information about overdiagnosis and false positives. The proposed cause of skepticism is that the evidence is surprising and different from other screening messages, a finding which suggests that skepticism might decline as the information becomes more familiar. The present research tested the hypothesis that skepticism declines over time with repeated exposure, and sought to replicate prior evidence for the antecedents of observed skepticism.

This longitudinal study recruited women ages 39-49 from two health systems. Women received a decision aid (DA) communicating mammography screening evidence prior to an annual well visit. Skepticism toward the DA information was measured immediately after the DA, after the clinic visit, and 3 months later. Hypothesis-relevant predictors of skepticism were assessed.

Skepticism was greater toward information about overdiagnosis and false positives compared to benefits, and skepticism was greater among participants who felt the evidence conflicted with past screening messages. We also observed that higher breast cancer anxiety was associated skepticism toward screening harms. Moreover, contrary to predictions, two facets of skepticism-reactance and disbelief-increased over time. Exploratory post hoc analyses suggested that increases in skepticism were associated with participants' perceptions that the DA conflicted with their doctors' screening message.

Some people express skepticism toward mammography evidence, and these feelings are associated with perceived conflicting messages and cancer anxiety. Skepticism may not decline over time if messages from other sources conflict with the DA information.

ClinicalTrials.gov registration NCT05838417.