When to stop breast cancer screening in dementia? Perspectives from patients and care partners

Introduction Guidelines recommend breast cancer screening up to age 75 or if life expectancy is > 10 years without specific guidance for dementia patients. One framework for individualizing preventive care in older adults proposes comparing an intervention's time‐to‐benefit (10 years for breast cancer screening) to an individual's life expectancy to inform when to stop a preventive intervention. Many older women with dementia who meet criteria for stopping screening continue to be screened. We aimed to better understand how dementia patients and care partners make decisions about stopping breast cancer screening. Methods We conducted semi‐structured interviews with 20 participants (8 care partners, 6 patient/care partner dyads) involving patients with mild to moderate dementia without history of breast cancer. Analysis used inductive/deductive coding. Results Participants viewed cancer screening positively and no participant (patient or care partner) perceived dementia as relevant to screening decisions. Care partners were more amenable to consider stopping screening than patients (9 of 14 care partners and 2 of 6 patients described scenarios in which they might consider stopping screening). Psychological distress was the most mentioned reason for stopping screening. Reactions to a message on screening cessation ranged from finding it interesting or helpful to disagreement. Care partners more often (4 out of 8) reported agreement with the message information than did patients (0 out of 6). Discussion Dementia patients and care partners may benefit from breast cancer screening decision support for higher value decision making.