Understanding motivations of older women to continue or discontinue breast cancer screening

• Published in: PloS one Vol. 20; no. 6; p. e0319141
• Main Authors: Weller, Susan C., Pappadis, Monique R., Krishnan, Shilpa, Stearnes, Marsja R., Sheffield, Kristin M., Tan, Alai, Qi, Jeffrey Z., Goodwin, James S.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 05.06.2025; Public Library of Science (PLoS)
• Subjects: Age; Aged; Analysis; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - psychology; Cancer screening; Care and treatment; Comparative analysis; Decision making; Demographic aspects; Diagnosis; Early Detection of Cancer - psychology; Education; Female; Health aspects; Hispanic American women; Humans; Life expectancy; Mammography; Mammography - psychology; Mass Screening - psychology; Medical screening; Medicine and Health Sciences; Mortality; Motivation; Qualitative analysis; Research and Analysis Methods; Social aspects; Social Sciences; Women; Womens health; United States
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0319141

Breast cancer screening guidelines indicate screening in women over 75 years of age is optional, depending upon patient health and preferences. To better understand the preferences and decision-making of older women, their experiences and perceptions concerning screening need to be linked to their intention to continue or discontinue screening. This study used a qualitative comparative analysis to identify the characteristics and themes linked to the intention to continue or discontinue screening. To capture the range of experiences and preferences, a purposive sample of community-residing adults (n = 59) was selected with equal representation of White, Black, and Hispanic women by age (70–74 years and 75 and older) and educational level (≤12 grade and >12 grade). In-depth qualitative interviews explored women’s perceptions of mammograms, the benefits and risks of screening, and personal screening experiences. Interviews were coded and quality-checked by two or more coders. A qualitative comparative analysis (QCA) identified combinations of personal characteristics and themes linked to the intention to continue (n = 32) or discontinue (n = 27) screening. Results indicated personal experiences were strongly linked to the intention to continue or discontinue. Women who mentioned recent screening (within three years) and either a spontaneously mentioned cancer story concerning a friend or family member or a doctor’s screening recommendation intended to continue screening (91% true positive rate, model sensitivity). Women who did not schedule screening and who did not mention a cancer story or a doctor’s recommendation (or neither) intended to discontinue screening (81% true negative rate, model specificity). These experiences transcended differences in race/ethnicity, age, and educational level. Continuation of breast cancer screening in older women is motivated by their personal screening history combined with cancer experiences and/or a doctor’s screening recommendation.