New Mammography Recommendations, Resulting Media Coverage Confused Women

RESEARCH TRIANGLE PARK, N.C.—The 2009 revised mammography guidelines confused women more than they helped, according to a new study by researchers at RTI International.

In November 2009, the U.S. Preventive Services Task Force (USPSTF), an independent panel of experts in primary care and prevention, released new recommendations endorsing biennial mammography screening for women age 50 to 74. For women age 40 to 49, the panel initially recommended against routine mammography screening, a change from previous recommendations, which resulted in considerable media controversy.

While the USPSTF clarified the recommendation by stating "The decision to start regular, biennial mammography screening before age 50 should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms," the new recommendations confused women (30.0%) more than they helped them understand when to get a mammogram (6.2%). Confusion was greatest among women age 40 to 49 and women who had never had a mammogram or who had one more than 2 years ago.

The study, published in the May 2011 issue of the American Journal of Preventive Medicine, analyzed news reports and social media posts around the time of the announcement, both of which shape public perceptions of and opinions about new information and topics. In addition, the study team surveyed more than 1,200 women for two months beginning one month after the announcement.

"Media coverage of the new recommendations peaked immediately following their release and was unbalanced," said Linda Squiers, Ph.D., senior health communication analyst at RTI. "The majority of news articles and social media posts were unsupportive of the recommendations."

Because, the new recommendations were released during the heated debate about health care reform legislation, they were portrayed by some as an example of how the Obama administration planned to ration health care if the legislation passed.

Of the more than 233 newspaper articles, blog posts, and tweets analyzed, more than half were unsupportive of the recommendation; only 17.6 percent were supportive. The most common reasons mentioned for being unsupportive of the new recommendations were the belief that delaying screening would lead to later detection of more advanced breast cancer and subsequently more breast cancer-related deaths (22.5 percent) and the belief that the recommendations reflected government rationing of health care (21.9 percent).

While the new recommendations received considerable coverage by the media, when surveyed, fewer than 25 percent of women could correctly identify the recommendations for women age 40 to 49 and women age 50 to 74.

"The USPSTF plays a vital role in reviewing the latest scientific evidence and advising providers and consumers about prevention," Squiers said. "For recommendations to be accepted by both groups, they first must be understood. In the field of health communication, message testing with individuals is frequently used to ensure that messages are understandable, credible, and use language that resonates with the target audience. Using message testing in the future may help identify specific components or words (e.g., routine, against) within the recommendations that could cause providers, consumers and advocacy agencies to be confused or concerned."