Differential appraisal of age thresholds for mammographic screening in Holland and Switzerland

Introduction: Information campaigns on breast cancer screening need to convince women above 50 years of age to have biannual mammograms, and women below 50 years of age that regular mammograms are not recommended for them. Earlier experiments in the Netherlands showed that type of evidence (statistical vs. anecdotal) and message framing (gain vs. loss) had no effects on attitudes to breast cancer screening. It also emerged that screening was widely accepted for women above 50, but women were reluctant to accept the exclusion of women under 50 from routine screening, although many and good arguments for this were presented. Aim: This study aims at finding out whether these results are specific to the Dutch culture by replicating the experiments in Ticino, Switzerland. Methods: A leaflet, constructed for the purposes of the study and informing women about breast cancer screening, served as the experimental stimulus in a pre-post-test design. Results: Findings show that in Ticino gain-framing appeared to be systematically more persuasive than loss-framing. Moreover, Ticino women were more willing than the Dutch to accept that women under the age threshold of 50 are not recommended routine mammography every 2 years. Borrowing from reactance theory, the higher acceptance of an age threshold in Ticino is explained by differences in the regulations. Lower attention to the issue there as well as the broader context of culturally tailored health communication also play a role.