Preconceptions influence women's perceptions of information on breast cancer screening: a qualitative study.
BACKGROUND
Screening for breast cancer has been subject to intense debate in recent decades regarding benefits and risks. Participation in breast cancer screening should be based on informed choice, and most countries approach this by sending information leaflets with invitations to attend screening. However, very little attention has been paid to the decision-making process and how the information leaflets are used and understood by women. The aim of this study is twofold. First, we use a theoretical framework to explore how the framing of information influences the intention to participate in breast cancer screening. Second, we discuss how information and attitudes held prior to receiving the invitation influence the perception of the balance between the benefits and risks harms of screening.


METHODS
We used a qualitative design and interviewed six women who were soon to receive their first invitation to participate in the breast screening programme in Denmark. The selected women received a copy of the official information leaflet 1 week before we interviewed them. The six women were interviewed individually using an interview guide based on the theory of planned behaviour. We used meaning condensation for our initial analysis, and further analysis was guided by the theory of cognitive dissonance.


RESULTS
For our participants, the decision-making process was dominated by the attitudes of the women's circle of acquaintances and, to a lesser extent, by the information that accompanied the screening invitation. Information that conflicted with attitudes the women already held was actively disregarded. The risk of overdiagnosis as a potentially harmful effect of participation in mammography screening was unknown to the women in our study. An isolated framing effect was not found.


CONCLUSIONS
Women have expectations about breast cancer screening that are formed before they receive information from the screening programme. These expectations compromise the perception of balance between screening benefits and potential harmful effects. They also influence the perception of the information in the breast screening leaflet. The phenomenon of overdiagnosis is unknown to the women.
Research Unit and Section for General Practice, Department of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark. mikael.jv.henriksen@gmail.com.|Centre for Clinical Education 5404, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark. mikael.jv.henriksen@gmail.com.
Mikael Johannes Vuokko
MJ
Henriksen
Research Unit and Section for General Practice, Department of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark. anngu@sund.ku.dk.
Ann Dorrit
AD
Guassora
Research Unit and Section for General Practice, Department of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark. jobr@sund.ku.dk.|Research Unit for General Practice, Region Zealand, Denmark. jobr@sund.ku.dk.
John
J
Brodersen
D001943:Breast Neoplasms / Q000175:diagnosis*; D003657:Decision Making; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008327:Mammography / Q000523:psychology*; D008403:Mass Screening / Q000379:methods / Q000523:psychology*; D008875:Middle Aged; D010465:Perception; D036301:Qualitative Research