Women’s participation in breast cancer screening in France – an ethical approach
1 Assistance Publique Hôpitaux de Paris, Hôpital Universitaire Georges Pompidou Corentin-Celton, Université Paris Descartes, 92130 Issy-les-Moulineaux, France
2 PRES Sorbonne Paris Cité/Ecole des hautes études en santé publique EHESP, Equipe MOS, Management des organisations de santé, 75014 Paris, France
3 Université Paris Descartes, EA 4569, Faculté de médecine, 75006 Paris, France
4 Institut de Recherche Interdisciplinaire sur les enjeux Sociaux (IRIS) Cnrs/Inserm/EHESS, Université Paris-Est Créteil, 93017 Bobigny cedex, France
5 Institut médico-légal, Centre hospitalo-universitaire de Caen, 14033 Caen cedex, France
6 Inserm, U1086 Cancers et préventions, Faculté de Médecine, 14076 Caen, France
7 Institut National du Cancer, 92513 Boulogne-Billancourt cedex, France
8 Université de Montpellier, Laboratoire Epsilon, 34000 Montpellier, France
9 Unité de Médecine sociale, Hôpital Universitaire Georges Pompidou Corentin-Celton, AP-HP, 4 Parvis Corentin Celton, 92130 Issy-les-Moulineaux, France
BMC Medical Ethics 2014, 15:64 doi:10.1186/1472-6939-15-64Published: 16 August 2014
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.
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.
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.