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Offering breast cancer patients treatment choice has become a priority as the involvement of patients in the decision-making process is associated with improved physical and psychological outcomes. As the Internet is increasingly being used by patients as a source of medical information, it is important to evaluate the quality of information relating to breast cancer on the Internet. We analysed 200 websites returned by google.co.uk searching “breast cancer treatment options” in terms of their typology and treatment options described. These were related to standard measures of health information quality such as the JAMA score and the presence of quality certifications, as well as readability. We found that health portals were of higher quality whilst commercial and professional websites were of poorer quality in terms of JAMA criteria. Overall, readability was higher than previously reported for other conditions, and Google ranked websites with better readability higher. Most websites discussed surgical and medical treatments. Few websites, with a large proportion being of commercial typology, discussed complementary and alternative medicine. Google ranked professional websites low whilst websites from non-profit organizations were promoted in the ranking.
In agreement with other studies , we found that healthp ortals and scientific journals consistently score better than other typologies using standard HIQ criteria such as JAMA and HONcode certification. Although the JAMA score and HONcode do not measure the accuracy of the information, a previous study analysing breast cancer website content found that educational websites, encompassing scientific journals and health portals, were more accurate [20,33]. This is likely due to review boards and policies for publication, that are in place for websites with these affiliations. The fact that these categories have high JAMA scores suggests that the JAMA criteria is a good proxy indicator for content accuracy. We found that health portals were also the easiest to read, along with government and non-profit websites. Not surprisingly, the technical content of scientific journals resulted in the lowest readability. Breast cancer information on the Internet, as assessed in this study, appears to be more readable compared to other health information on the Internet. Studies have found that the readability of information on Parkinson's disease was on average FK grade 12 and material on lateral epicondylitis grade 12 [5,6], while a study evaluating the readability of patient education material from surgical subspecialties found information to be at a high reading level, between 9 and 17 grade levels . Other studies on cancer have found a similar trend . Although breast cancer websites have good readability, they may still not be understood by the average patient as, to be understood by 75% of the population, readability should be at a sixth-grade level . Furthermore, we found a better readability, in terms of FK grades, for HONcode-certified websites and for the top 10 websites in the Google SERP, although this was not statistically significant for the SMOG score. Although we found the two measures to correlate very well, in agreement with another study , they are different in how they are derived as has been previously described. The SMOG grade is often considered better for the purpose of health information [37,38] but was suggested to be less accurate for grades <6 .