Women’s participation in breast cancer screening in France – an ethical approach

Abstract

BackgroundBreast cancer is a major public health challenge. Organized mammography screening (OS) is considered one way to reduce breast cancer mortality. EU recommendations prone mass deployment of OS, and back in 2004, France introduced a national OS programme for women aged 50–74 years. However, in 2012, participation rate was still just 52.7%, well short of the targeted 70% objective. In an effort to re-address the (in) efficiency of the programme, the French National Cancer Institute has drafted an expert-group review of the ethical issues surrounding breast cancer mammography screening.DiscussionPrompted by emerging debate over the efficiency of the screening scheme and its allied public information provision, we keynote the experts’ report based on analysis of epidemiological data and participation rate from the public health authorities. The low coverage of the OS scheme may be partly explained by the fact that a significant number of women undergo mammography outside OS and thus outside OS criteria. These findings call for further thinking on (i) the ethical principles of beneficence and non-malfeasance underpinning this public health initiative, (ii) the reasons behind women’s and professionals’ behavior, and (iii) the need to analyze how information provision to women and the doctor-patient relationship need to evolve in response to scientific controversy over the risks and benefits of conducting mammographic screening.SummaryThis work calls for a reappraisal of the provision of screening programme information. We advocate a move to integrate the points sparking debate over the efficiency of the screening scheme to guarantee full transparency. The perspective is to strengthen the respect for autonomy allowing women to make an informed choice in their decision on whether or not to participate.

Organized screening programmes for breast and cervical cancer in 17 EU countries: trajectories of attendance rates

“…Obstacles on the demand side may justify the slopes of other countries. In particular, France has increased the participation to a breast screening programme; however, by the end of the years under consideration in this study, it did not reach the threshold of 70% as set by the European Union [ 31 ]. A suggestion is provided by Ferrat et al, which states there are several barriers that affect attendance to screening programmes, and one of these is the perceptions of women with regard to the benefits of prevention [ 32 ].…”

Nudging in screening: Literature review and ethical guidance

“…Nudging is also debated in areas such as screening for abdominal aorta aneurisms [14], obesity [30][31][32][33], diabetes [34,35], chronic beryllium disease [36], and HIV [21,[37][38][39]. However, the majority of references are to various types of cancer screening [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58], predominantly breast cancer screening [2,[59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75].…”

Scarce information about breast cancer screening

“…[ 6 – 9 ] The main cause of this lack of knowledge is the scarce information conveyed to the public by health care providers or by written documents (leaflets, brochures, pamphlets). [ 10 – 15 ]…”