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Women's participation in breast cancer screening in France--an ethical approach.

Moutel G, Duchange N, Darquy S, de Montgolfier S, Papin-Lefebvre F, Jullian O, Viguier J, Sancho-Garnier H, GRED French National Cancer Institu - BMC Med Ethics (2014)

Bottom Line: 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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Assistance Publique Hôpitaux de Paris, Hôpital Universitaire Georges Pompidou Corentin-Celton, Université Paris Descartes, 92130 Issy-les-Moulineaux, France. gregoire.moutel@parisdescartes.fr.

ABSTRACT

Background: Breast 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.

Discussion: Prompted 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.

Summary: This 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.

No MeSH data available.


Related in: MedlinePlus

OS participation (%) by age bracket[8].
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Figure 2: OS participation (%) by age bracket[8].

Mentions: Participation rate is one indicator for assessing the performance of a screening programme. Based on epidemiological data and experts’ consensus recommendations, European guidelines set a target OS participation level of 70% as acceptable whereas 75% is the desirable level[7]. The 70% target level was set on the basis that a high rate of participation among invited women was necessary in order to maximize the mortality benefits of population-based breast cancer screening in a cost-effective manner. However, according to French Institute for Public Health Surveillance (InVS) data, participation in the French OS programme was only 52.7% in 2012, with no significant increase recorded since 2007 (Figure 2)[8]. The data also highlight strong regional disparities, with rates ranging from 67.6% in the Loire-Atlantique region down to 27.6% in Paris. Fifty-four French départements report over 55% participation, while 21—including six of the eight départements of the Greater Paris region—report less than 50% participation.


Women's participation in breast cancer screening in France--an ethical approach.

Moutel G, Duchange N, Darquy S, de Montgolfier S, Papin-Lefebvre F, Jullian O, Viguier J, Sancho-Garnier H, GRED French National Cancer Institu - BMC Med Ethics (2014)

OS participation (%) by age bracket[8].
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4151080&req=5

Figure 2: OS participation (%) by age bracket[8].
Mentions: Participation rate is one indicator for assessing the performance of a screening programme. Based on epidemiological data and experts’ consensus recommendations, European guidelines set a target OS participation level of 70% as acceptable whereas 75% is the desirable level[7]. The 70% target level was set on the basis that a high rate of participation among invited women was necessary in order to maximize the mortality benefits of population-based breast cancer screening in a cost-effective manner. However, according to French Institute for Public Health Surveillance (InVS) data, participation in the French OS programme was only 52.7% in 2012, with no significant increase recorded since 2007 (Figure 2)[8]. The data also highlight strong regional disparities, with rates ranging from 67.6% in the Loire-Atlantique region down to 27.6% in Paris. Fifty-four French départements report over 55% participation, while 21—including six of the eight départements of the Greater Paris region—report less than 50% participation.

Bottom Line: 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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Assistance Publique Hôpitaux de Paris, Hôpital Universitaire Georges Pompidou Corentin-Celton, Université Paris Descartes, 92130 Issy-les-Moulineaux, France. gregoire.moutel@parisdescartes.fr.

ABSTRACT

Background: Breast 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.

Discussion: Prompted 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.

Summary: This 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.

No MeSH data available.


Related in: MedlinePlus