Grant Number:	4R37CA254926-06 Interpret this number
Primary Investigator:	Scherer, Laura
Organization:	University Of Colorado Denver
Project Title:	Understanding Affective Processing of Scientific Evidence to Promote Informed Choice for Breast Cancer Screening
Fiscal Year:	2026

Abstract From 2009 to 2024, the United States Preventive Services Task Force (USPSTF) recommendation for mammography screening highlighted a tailored approach wherein women age 40-49 talk with their doctor and make an informed choice about when to initiate screening. In 2009, the change in emphasis from strongly promoting mammograms to promoting informed choice for women in their 40s constituted a medical reversal, in the sense that this new message was very different from past messages and people’s expectations. Evidence began emerging showing that screening messages that conveyed information about both the benefits and harms of screening elicited negative reactions like disbelief and suspicion. The result was a delicate situation in which there was need to convey the evidence to women so they can make an informed choice, but also a need to do it in a way that maintained credibility and trust. Our research conducted as part of this R37 sought to identify the underlying reason for these negative reactions, and two hypotheses were tested: An affective hypothesis proposed that women are skeptical of balanced screening messages because they convey information about screening that is emotionally aversive. A competing “Bayesian updating” hypothesis proposed that women are making a normative probabilistic judgment that information that is very surprising and different from other messages is unlikely to be true. We found no evidence supporting the affective hypothesis, and consistent evidence supporting the Bayesian updating hypothesis, indicating that informational updating (e.g., message consistency and repetition) rather than emotional calming or emotional countering may be the more effective approach for addressing skeptical reactions. Then, in April 2024, the USPSTF changed its recommendation again, indicating that all women should start screening biennially at age 40. This new recommendation deemphasized informed choice, but at the same time the USPSTF continued to make a strong ethical argument in favor of informed choice at all levels of its recommendations. As a result, the same delicate communication environment exists, but informing women faces increased practical barriers. Explaining the evidence takes time, whereas simply referring patients for screening at age 40 is both efficient and justifiable because it is guideline concordant. Clinicians and health systems are unlikely to incur the costs of providing information about screening benefits and harms if they believe no one wants this information, or worse, that it might deter some people from screening altogether. As a result, we need to understand what information people do value, and feel is critical to receive prior to having mammography. We therefore propose a nationally representative survey in this 2-year extension to identify what kind of demand exists for this information, given this new guideline environment. The proposed research will help us to communicate the evidence in a way that maximizes comprehension, engagement, and trust, which will be the final product of this work.




Laypeople's Perceptions of Clinician Performance Metrics Based on Cancer Screening Attendance.
Authors: Scherer L.D. , Lewis C.L. , Cappella J.N. , McCaffery K. , Hersch J. , Morse B. , Tate C. , Parmet T. , Mosley B. , Smyth H.L. , et al. .
Source: Jama Health Forum, 2026-04-03 00:00:00.0; 7(4), p. e260714.
EPub date: 2026-04-03 00:00:00.0.
PMID: 41996106
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Media Reporting of the 2024 US Preventive Services Task Force Mammography Guideline Update.
Authors: Parmet T. , Li Y. , Cappella J. , Scherer L.D. , Waters E.A. , Housten A.J. .
Source: Jama Network Open, 2026-03-02 00:00:00.0; 9(3), p. e260040.
EPub date: 2026-03-02 00:00:00.0.
PMID: 41770568
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Trust in the healthcare system declines after exposure to information about the harms and benefits of breast cancer screening.
Authors: Parmet T. , Yoder G. , Morse B. , Cappella J. , Schapira M. , Lewis C. , McCaffery K. , Smyth H. , Hersch J. , Scherer L.D. .
Source: Journal Of Health Psychology, 2025 Nov; 30(13), p. 4091-4097.
EPub date: 2025-02-07 00:00:00.0.
PMID: 39917819
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Mammography Screening Preferences Among Screening-Eligible Women in Their 40s.
Authors: Scherer L.D. , Lewis C.L. , Hersch J. , Cappella J.N. , Schapira M.M. .
Source: Annals Of Internal Medicine, 2025 Jul; 178(7), p. 1061-1062.
PMID: 40658972
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Skeptical reactions to breast cancer screening benefits and harms: Antecedents, consequences, and implications for screening communication.
Authors: Scherer L.D. , Lewis C.L. , Cappella J.N. , Hersch J. , McCaffery K. , Tate C. , Smyth H.L. , Mosley B. , Morse B. , Schapira M.M. .
Source: Health Psychology : Official Journal Of The Division Of Health Psychology, American Psychological Association, 2025 Jun; 44(6), p. 608-619.
EPub date: 2024-11-25 00:00:00.0.
PMID: 39585772
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Evaluation of how US women react to a decision aid informing them of the harms and benefits of mammography: a qualitative study.
Authors: Morse B. , Parmet T. , Yoder G. , Tate C.E. , Lewis C.L. , McCaffery K. , Cappella J.N. , Hersch J. , Schapira M.M. , Scherer L.D. .
Source: Bmj Open, 2025-03-18 00:00:00.0; 15(3), p. e087997.
EPub date: 2025-03-18 00:00:00.0.
PMID: 40107692
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Mammography Screening Preferences Among Screening-Eligible Women in Their 40s : A National U.S. Survey.
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Source: Annals Of Internal Medicine, 2024 Aug; 177(8), p. 1069-1077.
EPub date: 2024-07-16 00:00:00.0.
PMID: 39008858
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Assessing and Understanding Reactance, Self-Exemption, Disbelief, Source Derogation and Information Conflict in Reaction to Overdiagnosis in Mammography Screening: Scale Development and Preliminary Validation.
Authors: Scherer L.D. , Suresh K. , Lewis C.L. , McCaffery K.J. , Hersch J. , Cappella J.N. , Morse B. , Tate C.E. , Mosley B.S. , Schmiege S. , et al. .
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2023 Oct-Nov; 43(7-8), p. 789-802.
EPub date: 2023-09-14 00:00:00.0.
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Operating on Anxiety: Negative Affect toward Breast Cancer and Choosing Contralateral Prophylactic Mastectomy.
Authors: Silverstein M.C. , Lee C.N. , Scherer L.D. , Phommasathit C. , Merrill A.L. , Peters E. .
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2022-09-05 00:00:00.0; , p. 272989X221121134.
EPub date: 2022-09-05 00:00:00.0.
PMID: 36059240
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Cancer Misinformation and Harmful Information on Facebook and Other Social Media: A Brief Report.
Authors: Johnson S.B. , Parsons M. , Dorff T. , Moran M.S. , Ward J.H. , Cohen S.A. , Akerley W. , Bauman J. , Hubbard J. , Spratt D.E. , et al. .
Source: Journal Of The National Cancer Institute, 2022-07-11 00:00:00.0; 114(7), p. 1036-1039.
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The Impact of 4 Risk Communication Interventions on Cancer Screening Preferences and Knowledge.
Authors: Valentine K.D. , Wegier P. , Shaffer V.A. , Scherer L.D. .
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2022 Apr; 42(3), p. 387-397.
EPub date: 2021-09-01 00:00:00.0.
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Interpersonal (mis)perceptions and (mis)predictions in patient-clinician interactions.
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