[Informed choice in breast cancer screening: the role of education]

Abstract

Objective: To evaluate the effect of receiving information about the benefits and harms of breast cancer screening in informed choice, according to educational level.

Method: Secondary analysis of a randomized, controlled study, in four screening programs, in Catalonia and the Canary Islands (Spain). We analyzed 400 women who were going to be invited to participate for the first time. The intervention group received a decision aid that showed the benefits and harms of screening. The control group received a standard brochure that recommended participating in the screening program. Educational level was grouped into two categories, low and high. The primary outcome was informed choice defined as adequate knowledge and consistency between attitudes and intentions.

Results: The intervention produced a greater increase in knowledge in women with a high educational level compared to those with a lower educational level. Among women who received the intervention, informed choice was almost three times higher in those with a high educational level (27% versus 11%). No differences were observed between educational levels in decisional conflict, confidence in the decision, anxiety and worry about breast cancer, in the intervention and control groups.

Conclusions: A decision aid for breast cancer screening had much more impact on informed choice among women with a high educational level. In women with low educational level, the attitude towards screening improved and there was an increase in the intention to be screened.

Keywords: Breast cancer; Cribado; Cáncer de mama; Detección precoz; Early detection; Educational level; Efectos adversos; Elección informada; Harms; Informed choice; Nivel educativo; Overdiagnosis; Screening; Sobrediagnóstico.