Objective: The relative benefits and risks of screening programmes for breast cancer have been extensively debated. This study aimed to 1) quantify, and investigate heterogeneity in, women’s preferences for the benefits and risks of a national breast screening programme (NBSP), and 2) understand the effect of risk communication format on these preferences.
Methods: An online discrete choice experiment (DCE) survey was designed to elicit preferences from female members of the public for a NBSP described by three attributes (probability of detecting a cancer, risk of unnecessary follow-up and out-of-pocket screening costs). Survey respondents were randomised to one of two surveys, presenting risk as either percentages only (PO) or icon arrays and percentages (IAP). Respondents were required to choose between two hypothetical NBSPs or no screening in 11 choice-sets generated using a Bayesian D-efficient design. The trade-offs women made were analysed using heteroskedastic conditional logit and scale-adjusted latent-class models.
Results: 1018 women completed the DCE (version PO =507; IAP=511). The results of the heteroskedastic conditional logit model suggested, on average, women were willing-to-accept 1.72 (CI:1.47-1.97) additional unnecessary follow-ups and willing-to-pay £79.17 (CI:£66.98-£91.35) for an additional cancer detected per 100 women screened. Latent-class analysis indicated substantial heterogeneity in preferences with six latent-classes and three scale-classes providing the best fit. The risk communication format received was not a predictor of scale or preference-class membership.
Conclusion: Most women were willing to trade-off the benefits and risks of screening but decision-makers seeking to improve uptake should consider the disparate needs of women when configuring services.