Cancer Screening Benefits and Harms: News Coverage and Provider Perceptions Public Deposited

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  • March 22, 2019
  • Elstad, Emily A.
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
  • Background. Cancer screening poses both potential benefits and potential harms to patients. This dissertation explored news coverage and provider perceptions of screening by comparing colonoscopy, which results in net benefit for many adults, to the prostate-specific antigen (PSA) testing, which may do more harm than good. Methods. Study 1 data came from a 2012 survey of clinicians (n=126) from 24 family/internal medicine practices in North Carolina. Analyses examined clinicians' perceptions of screening benefits and harms and potential mediators of the relationship between screening test and clinicians' likelihood estimates. Study 2 data came from a content analysis of articles on PSA testing or colonoscopy in the top 10 U.S. print newspapers. Analyses examined whether newspapers' portrayal of screening changed after the 2008 U.S. Preventive Services Task Force recommendation changes. Results. In Study 1, we found that clinicians perceived PSA testing to have greater likelihood of harm than colonoscopy and lower likelihood of lengthening life. These associations were mediated by clinicians' gist of screening and perceived benefits, but not perceived harms. In Study 2, we found that mentions of PSA harms in newspapers were stable before 2008 but increased after that time. Mentions of PSA benefits and colonoscopy harms and benefits did not change over time. Discussion. Clinicians and the news media both fell short as sources of information on PSA testing and colonoscopy. Patients may be receiving imbalanced information on cancer screening. Thus, clinicians, experts in dissemination, and the USPSTF may face hurdles in communicating new recommendations to patients. Messages to clinicians intended to decrease over-recommendation of PSA testing may need to emphasize its relatively few benefits rather than its many harms.
Date of publication
Resource type
Rights statement
  • In Copyright
  • Brewer, Noel T.
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2014

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