# Messaging Strategies to Reduce Breast Cancer Over-Screening in Older Women

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2022 · $163,591

## Abstract

PROJECT SUMMARY
 This administrative supplement proposal focuses on bioethics research around the use of persuasion in
health communication, specifically in the context of reducing breast cancer over-screening. Mammography
screening may decrease breast cancer mortality and morbidity but the potential benefits are often delayed for
many years while significant harms can occur in the short term. The harms of routine screening outweigh the
benefits among older women with limited life expectancies, but many of these women continue to be screened,
highlighting the need for interventions to promote appropriate screening cessation and reduce over-screening
in older women. Our project (R01AG066741) is studying the novel use of messaging interventions, via
clinician-patient communication and other sources (family, friends, and the media), to reduce over-screening.
 Numerous health communication strategies, such as establishing credibility, using emotional appeals,
and using stories, are inherently persuasive and used to change behaviors. The parent R01 project plans to
test various messages employing such persuasive strategies but the potential ethical implications are unclear.
One perspective asserts that using persuasion may be manipulative and threat patient autonomy while others
argue that it is essential to guide patients towards options that promote benefits (beneficence) and minimize
harms (non-maleficence). It is not clear at what point across the benefits/harms balance spectrum it may be
ethically acceptable to shift from informing to persuading or what forms of persuasion are acceptable in the
context of reducing over-screening.
 This supplement project aims to build upon the parent project to address ethical issues around using
persuasion to reduce breast cancer over-screening. First, we will examine older women’s moral beliefs and
values on this topic. We propose both qualitative in-depth interviews of 30 older women (Aim 1) and
quantitative surveys of 3000 older women (Aim 2), where the latter leverages a nationally representative online
survey that is already planned as part of the parent project. Then, we will convene an expert panel of
bioethicists, clinicians, health communication and cancer screening researchers. The panel will deliberate and
reflect upon the empirical results from Aims 1 and 2, existing literature on breast cancer screening and
messaging, and the competing ethical principles of patient autonomy and beneficence/non-maleficence, to
make recommendations on how to use persuasion in de-implementing over-screening (Aim 3).
 The proposed project will build on the existing R01 and 1) identify messages that are not only effective
for reducing over-screening but are also ethically acceptable, and 2) develop an ethical framework to guide the
next-step messaging intervention. More broadly, the results will help address the appropriate and effective use
of health communication tools in both clinical care and public health in the con...

## Key facts

- **NIH application ID:** 10592067
- **Project number:** 3R01AG066741-02S1
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Nancy Schoenborn
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $163,591
- **Award type:** 3
- **Project period:** 2021-04-15 → 2025-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10592067

## Citation

> US National Institutes of Health, RePORTER application 10592067, Messaging Strategies to Reduce Breast Cancer Over-Screening in Older Women (3R01AG066741-02S1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10592067. Licensed CC0.

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