The More You Know, The Less You Want to Know?

National Public Radio's science correspondent Shankar Vedantam recently reported on a study conducted by economists Giulio Zanella (University of Bologna, Italy, and University of California, Santa Barbara) and Ritesh Banerjee to examine "how a woman's propensity to perform an annual mammography changes over time after a co-worker is diagnosed with breast cancer."

Using employer records from a large, not-for-profit medical organization, Zanella and Banerjee constructed a panel dataset (2002-2004) containing demographic, professional, socio-economic, and health information, as well as information about the employee's physical location in the workplace (building, floor, etc).  Their analyses focus on women who are at least 50 years old because yearly mammograms are recommended for this age group.  Studies sometimes refer to lack of insurance, high copays, and lack of reminders as  potential barriers to women getting preventative tests such as mammograms.  However, employees of this particular organization were enrolled in a comprehensive medical plan offering free mammograms; the screening facility was located on campus; and the women were reminded about the recommended annual mammogram each time they visited their primary care physician.

Zanella and Banerjee found that:
  • In the year in which a woman is diagnosed with breast cancer, those women who are spatially closer to her in the workplace become 8 percentage points less likely to get a mammography relative to all other women, off of a baseline screening rate of about 70 percent.
  • This effect is stronger for women exposed to more severe cases of breast cancer.  
  • It is also stronger and more persistent for women who are neither medical doctors nor nurses.
  • It is more pronounced among women with a higher propensity to screen.
  • The effect persisted for two years after the cancer diagnosis.
  • Exposure to non-breast cancer events did not affect the propensity to get a mammogram. 

The researchers discuss several potential mechanisms that might explain why a colleague's breast cancer diagnosis would influence one's propensity to get screened for breast cancer, but find only two of them compelling.  The first is that, since the mammograms were offered by the employer, employees may be getting screened elsewhere for fear that a breast cancer diagnosis through workplace screening could negatively impact their career or health coverage.   It is also plausible, Zanella and Banerjee argue, that employees exhibited "information aversion"--the idea that people sometimes avoid information that can be scary: finding out that a colleague has breast cancer may "make the disease more salient and induce a higher perceived probability of developing the disease," and may also lead one to realize that "the physical, psychological, or economic consequences of being diagnosed with breast cancer are worse than [one] thought."

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Frederique Laubepin

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