To the Editor The article by Marcotte et al 1 of a trial comparing opt-out vs opt-in patient outreach strategies for breast cancer screening left me bewildered. Indeed, our first duty: shared decision-making, a demanding process that requires 4 steps, 2 has been bypassed. An audiocare message requiring a veteran to confirm that they would like to participate in screening and have consult sent or a consult automatically sent and the veteran called to schedule screening 1 precludes (1) the first step, reassuring by indicating that both options, participating or not, are equally valuable according to personal values; and (2) the second step, informing about benefits and harms with the support of adequate pictograms. 2 Informing is a challenge because breast cancer screening is controversial. 3 According to a Cochrane review, 4 5 cancer deaths are averted per 10 000 women screened but for every woman who avoids a breast cancer death through screening, 10 women will be treated unnecessarily. Furthermore, the time frame matters, outreach strategies sell a 1-round screening, whereas regular screening every 2 years for 10 years is a prerequisite for efficacy.I am afraid that this looks like the foot-in-the-door technique (referring to a door-to-door salesperson who keeps the door from shutting with their foot so customers have no choice but to listen), a compliance tactic that aims to get a person to agree to a large request by having them agree to a modest request first. This is a widespread issue; another example is the mailing of fecal test kits for colorectal cancer screening. 5 However, it could be worse, considering that in Uruguay in 2006, it became mandatory for all women aged 40 to 59 years to have a mammogram every 2 years.