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Steven Woloshin, MD, MS; Lisa M. Schwartz, MD, MS; Stephanie J. Byram, MS, PhD; Harold C. Sox, MD; Baruch Fischhoff, PhD; H. Gilbert Welch, MD, MPH

Arch Intern Med. 2000;160:1434-1440.

Background  The fractious public debate over mammography screening recommendations for women aged 40 to 49 years has received extensive attention in medical journals and in the press.

Objective  To learn how women interpret the mammography screening debate.

Methods  We mailed a survey to a random sample of American women 18 years and older, oversampling women of screening age (40-70 years). Sixty-six percent of women completed the survey (n=503).

Main Outcome Measures  The main outcome measures were women's reactions to the debate, their suggestion for the starting age for mammography screening, and their understanding of the source of the debate.

Results  Almost all women (95%) said that they had paid some attention to the recent discussion about mammography screening. Only 24% said the discussion had improved their understanding of mammography, while 50% reported being upset by the public disagreement among screening experts. Women's beliefs about mammography differed from those articulated by experts in the debate. Eighty-three percent believed that mammography had proven benefit for women aged 40 to 49 years, and 38% believed that benefit was proven for women younger than 40 years. Most women suggested that mammography screening should begin before age 40 years, while only 5% suggested a first mammogram should be performed at 50 years or older. In response to an open-ended question about why mammography has been controversial, 15% cited concerns about the potential harms of radiation and another 12% cited questions about efficacy. Nearly half (49%), however, identified costs as the major source of debate (eg, "Health maintenance organizations [HMOs] don't want to pay for mammography").

Conclusions  Most women paid attention to the recent debate about routine mammography screening for women aged 40 to 49 years, but many believed the debate was about money rather than the question of benefit. Policy makers issuing recommendations about implementation of large-scale mammography screening services need to consider how to effectively disseminate their message.

From the Veterans Affairs Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vt (Drs Woloshin, Schwartz, and Welch); Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH (Drs Woloshin, Schwartz, Sox, and Welch); Norris Cotton Cancer Center and Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH; and Department of Social and Decision Sciences, Carnegie-Mellon University, Pittsburgh, Pa (Drs Byram and Fischhoff).

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