INTEREST IN CANCER SCREENING WITH NO BENEFITS: A NATIONALLY REPRESENTATIVE U.S. SURVEY

Purpose:   Surveys have shown that the vast majority of people endorse the idea of cancer screening, and about half of people in the U.S. and Britain want screening even if the cancer detected were untreatable (Waller et al., 2016) and would never grow or spread (Schwartz et al., 2004). These findings suggest that many people want cancer screening even when screening does not save lives. However, no research has explicitly asked participants if they would want a screening test that unquestionably does not save lives or extend life. The purpose of the present study was to determine whether anyone would want such a test, and if so, why.

Method: In a nationally representative U.S. survey, 1601 men and women age 40-70 (M=55.96, SD=8.40) considered a screening test for either prostate or breast cancer that “unquestionably does not extend life or reduce the chance of death from cancer”. The description of screening harms was randomized: Half of participants were told that harms included “unnecessary treatment,” whereas others were given a detailed list of the harms of unnecessary treatment (e.g., anxiety, financial debt, infection, hospitalization, death). Participants indicated whether they would want to get this test (yes/no), and whether they believed that the test saved lives (regardless of what they were told). Participants also reported cancer anxiety, perceived cancer risk, perceived test risk, and demographics.

Result:   Overall, 43% of participants indicated that they would want to get the described screening test. 51% of participants wanted the test when the harms were “unnecessary treatment,” whereas 34% wanted the test when the harms were described in greater detail, χ²(1)=44.74, p<.001. Only 54% of the sample believed that the test did not save lives, but even of these participants, 33% stated that they wanted the screening test. Decisions to get this test were associated with cancer anxiety (r=.21, p<.001), perceived test risk (r=-.32, p<.001) and belief that the test saved lives (r=.21, p<.001).

Conclusion:   Almost half of U.S. participants wanted cancer screening in the absence of any survival benefit, and approximately one-third want screening even when the test had a long list of possible harms. Reasons for wanting this screening test included cancer anxiety, low perceived riskiness of screening, and inability to accept that the test lacked benefits.