Increasing acceptance of age thresholds for mammographic screening by applying the theory of regulatory focus

BACKGROUND: Breast cancer is the most common cancer as well as the leading cause of cancer death in Swiss women. Each year 5250 women develop breast cancer, while approximately 1350 die from it. To decrease the number of breast cancer deaths, several Swiss cantons have introduced screening programs among women aged 50 to 75. These age thresholds have not been chosen haphazardly. They are based on extensive medical research weighing the advantages of mammographic screening (possible early cancer detection) against its costs (e.g., radiation exposure, misdiagnoses, financial and emotional burden). Despite the strong evidential basis underlying the age thresholds for breast cancer screening, studies demonstrate that young women are often reluctant to accept the arguments justifying their exclusion from preventive screening programs. These findings are consistent regardless of the format (statistical vs. anecdotal evidence) and frame (gain vs. loss) in which the arguments are presented. It seems that women’s fear of breast cancer and death persistently outweighs all reasonable arguments.

OBJECTIVES: This project aims to explore the ways in which young, healthy women can be persuaded to avoid unnecessary screening when arguments fail. The project applies the theory of regulatory focus and distinguishes between two mindsets in which screening decisions are made: (1) a prevention focus, which is risk-aversive and aimed at avoiding negative outcomes, and (2) a promotion focus, which is risk-taking and directed at realizing goals. In this project, it is assumed that by minimizing the attention to screening and simultaneously priming a promotional mindset, young women’s fear of breast cancer can be made less salient. Consequently, it is hypothesized that their acceptance of the screening thresholds will increase.

METHODS: The project consists of three consecutive studies. The first study concerns a survey of a representative group of women across Switzerland that may serve as a baseline to map out young women’s perceptions and attitudes towards breast cancer (screening). The second study applies the findings of the baseline survey to inform the design of an experimental study using video-vignettes. The experiment will focus on the effects of mindset priming on young women’s attitudes towards mammographic screening. Lastly, the third study seeks to test these effects longitudinally. An experimental setup is used to test the long-term effects of engaging in a program promoting healthy behaviors (i.e., priming a promotion focus) on breast cancer screening intentions.

IMPLICATIONS: The implications of the present project are multifold. The project has significant scientific value as it seeks to validate and build forth on previous studies conducted in Switzerland and the Netherlands. Additionally, its set-up will allow for micro-cultural comparisons to be made. Furthermore, the project has the potential to shed light on the ways in which health messages are designed and processed by audiences that are reluctant towards attempts at rational persuasion. Thereby, the project can be seen to have theoretical as well as practical implications. Its findings may be relevant to scholars from a variety of fields, yet also to policy makers, public health professionals, and the public at large. Encouraging young women to have trust in, and comply with, evidence-based screening guidelines, in the long term, will allow policy makers to allocate the scarce resources available for disease prevention, detection, and cure in a more effective way. The project thus not only serves an interdisciplinary scientific agenda, but also a political and societal purpose.