Tag Archives: mammography

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Mary McNaughton-Collins, MD, MPH

New "Foundation Perspectives" Video: NEJM Study on Screening Mammography and Breast Cancer Overdiagnosis

The recent New England Journal of Medicine paper titled “Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence” look at thirty-two years of cancer statistics in the U.S. and comes to the startling conclusion that roughly 1.3 million women have been overdiagnosed with breast cancer. In our newest “Foundation Perspectives” video, Dr. Mary McNaughton-Collins, medical director at the Informed Medical Decisions Foundation and a primary care doctor, gives us her take on the importance of this study. She provides a brief overview of the authors’ findings, explains why the overdiagnosis of breast cancer is harmful and provides her view on how these findings will affect how she engages women in a shared decision making conversation about screening mammograms. Continue reading
Posted in Current News | Tagged breast cancer, mammography, overdiagnosis, overtreatment, shared decision making | Permalink

A Q&A with Carrie Levin: Moving Toward Shared Decision Making as Second Nature

Carrie Levin, PhDHow are patients and providers engaging in shared decision making conversations about cancer screening? They aren't engaging frequently enough. The Informed Medical Decisions Foundation has funded two studies on this question—the DECISIONS Study in 2007 and the TRENDS Study in 2011. In both instances, it was revealed that shared decision making (SDM) conversations do not occur very often in this country, especially around cancer screening decisions. A key aspect of an SDM conversation is discussing both the pros and cons of each option, including the option to not have the test or treatment. We found that providers talk about the pros way more than the cons. The TRENDS Study looked at the state of medical decision making for nine common medical decisions, three of which were cancer screenings (breast, colorectal, and prostate). The study revealed that the pros of screening were discussed 51% to 67% of the time, while the cons were addressed only 7% to 14% of the time. That’s a pretty big difference between pro and con discussions. Why is it important that both the pros and cons be discussed?   Our health care system is still very much a fee-for-service environment where providers are paid based on how many services they provide, instead of on the quality or value of care they provide. This makes for misaligned incentives that suggest to patients a “just do it” attitude. Informing patients of both the pros and the cons of the choices at hand helps paint a full picture. “Just having a test” sounds like a simple task, but it is one that can quickly cascade. And patients need ALL of the information up front in order to make informed choices. Why is SDM important? Because of your preferences as a patient. I say “your” because we are all, at some point, a patient. SDM allows us to surface the preferences each of us has as a patient. These preferences and values are key in cancer screening decisions because people can make completely different decisions based on the facts and how they interpret that information. If breast cancer runs in my family, I might make a different decision than my next door neighbor who doesn't have a family history of breast cancer. If I’m 80 years old, I would likely have a very different perspective on screening for cancer than if I were in my 50s. I think we sometimes consider screening decisions as, “Eh, it’s a blood test.” Or “It’s just a mammogram. It’s not that big a deal.”  Well, we’re not thinking about the downstream effects—“If I have this screening, what might it lead to? Unnecessary biopsies, false positives, etc.” Or if I don’t get screened, I might worry that I have cancer that hasn’t been detected. The decision to be screened for cancer is a personal choice, and it’s not “one size fits all.” It’s going be different for everybody. And that’s why SDM conversations are crucial. How do we make SDM part of routine care?  We need a shift on both the provider side and the patient side. The patient side is happening slowly—patients are becoming more engaged and activated in their health care; they want to be at the center of their care. This new generation of patients has replaced the paternalistic approach to medicine with a participatory approach. I think about my grandmother and her views on medicine, “Whatever the doctor says, they’re the doctor. They know all.” Whereas, I might think, “Wait a second. My doctor doesn’t know everything.” They might know the evidence, but they don’t know about me and my life and my goals and concerns. On the provider side, we are starting to see training for practicing providers in SDM, which is great. But we also need to provide our future clinicians with the skills to partner with patients. I think we still have a long way to go, but providers are beginning to realize, “Okay, I know a whole lot about the science, but there is this whole other piece that really needs to play into this.” We've seen a seismic shift in the last 25 years. And although the road is long, I’m very hopeful and confident that in the next 25 years, it will be second nature to engage patients in conversations about these important health care decisions.
Posted in Current News | Tagged cancer screening, mammography, patient engagement, shared decision making, TRENDS Study | Permalink

In The News

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[The Boston Globe Daily Dose Blog] 1 Million Women 'Overdiagnosed' with Breast Cancer Due to Mammograms, Controversial Study Suggests

Others, however, defended the researchers' conclusions, saying the study verifies research data that's been published in other countries. "They just took a different way of looking at the likely benefits of mammographic screening and the overdiagnosis rate," said Dr. Michael Barry, president of the Informed Medical Decisions Foundation. Read more >  
Tagged breast cancer, mammography, overtreatment | Permalink

[news@JAMA] Author Insights: Patients Often Excluded From Decision Making About Common Conditions

To better gauge the extent to which patients are involved in decision making about 10 common medical issues, Floyd J. Fowler, PhD, and colleagues at the Informed Medical Decisions Foundation in Boston surveyed about 3000 patients. Patients were asked about the discussions they had with their physicians about 10 common medical decisions (whether to take medication for high blood pressure, high cholesterol, or depression; whether to be screened for breast, prostate, or colon cancer; or whether to undergo knee or hip replacement for osteoarthritis or surgery for cataracts or low back pain). Read more >
Tagged breast cancer, DECISIONS Study, mammography, patient engagement, prostate cancer, prostate cancer screening, shared decision making, TRENDS Study | Permalink

Informed Medical Decisions Foundation Funded Research

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Overdiagnosis in Screening Mammography: Examination of Women's Attitudes and Responses to Information about Overdiagnosis

The overall purpose of this research is to contribute to improving communication with the community about screening mammography. The research involves developing and evaluating educational materials and strategies to meet the important ethical objective of providing balanced information about screening outcomes in order to support screening decisions. Continue reading
Posted in Decision Quality, George Bennett Grants, Investigator-Initiated Research, Patient Involvement, Patient Knowledge, Patient Preferences | Tagged mammography, overdiagnosis | Permalink