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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

Mammography participation (%) by age bracket under organized breast cancer screening (OS) and individual detection procedures from 2008 to 2009[9].
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Figure 3: Mammography participation (%) by age bracket under organized breast cancer screening (OS) and individual detection procedures from 2008 to 2009[9].

Mentions: However, a significant number of mammographies that should be performed in OS are still prescribed outside the programme, and thus outside the OS inclusion criteria (Figure 3)[9]. Mammographies performed outside OS and its criteria should not normally involve women other than those presenting high risk factors (family history, genetic predisposition, personal history of thoracic irradiation or at-risk benign tumours) or those with clinical symptoms. Among the women aged 50–74 who undergo mammographies outside OS, only 7–8% would be diagnosed or monitored as belonging to the high-risk population, which leaves more than 90% that would otherwise meet the OS criteria. As these extra-OS procedures are performed outside accredited management centres, the data does not enter into the epidemiological evaluation of OS, which thus further lowers the OS participation rate. Under the French health insurance system, mammographies are always reimbursed, which may explain why a number of women meeting the criteria do not opt into the OS programme.


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)

Mammography participation (%) by age bracket under organized breast cancer screening (OS) and individual detection procedures from 2008 to 2009[9].
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Mammography participation (%) by age bracket under organized breast cancer screening (OS) and individual detection procedures from 2008 to 2009[9].
Mentions: However, a significant number of mammographies that should be performed in OS are still prescribed outside the programme, and thus outside the OS inclusion criteria (Figure 3)[9]. Mammographies performed outside OS and its criteria should not normally involve women other than those presenting high risk factors (family history, genetic predisposition, personal history of thoracic irradiation or at-risk benign tumours) or those with clinical symptoms. Among the women aged 50–74 who undergo mammographies outside OS, only 7–8% would be diagnosed or monitored as belonging to the high-risk population, which leaves more than 90% that would otherwise meet the OS criteria. As these extra-OS procedures are performed outside accredited management centres, the data does not enter into the epidemiological evaluation of OS, which thus further lowers the OS participation rate. Under the French health insurance system, mammographies are always reimbursed, which may explain why a number of women meeting the criteria do not opt into the OS programme.

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