1. Women’s participation in breast cancer screening in France – an ethical approach
- Author
-
Nathalie Duchange, Frédérique Papin-Lefebvre, Jérôme Viguier, S. Darquy, Sandrine de Montgolfier, Grégoire Moutel, Hélène Sancho-Garnier, Odile Jullian, Unité de Médecine Sociale, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpital Corentin Celton [Issy-les-Moulineaux], EA Management des Organisations de Santé ( EA MOS ), École des Hautes Études en Santé Publique [EHESP] ( EHESP ) -PRES Sorbonne Paris Cité, Laboratoire Ethique Politique et Santé ( EA 4569 ), Université Paris Descartes - Paris 5 ( UPD5 ), Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - sciences sociales, politique, santé ( IRIS ), Université Paris 13 ( UP13 ) -École des hautes études en sciences sociales ( EHESS ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -PSL Research University ( PSL ), Cancers et préventions, Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Caen Normandie ( UNICAEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Institut médico-légal [Caen] ( IML ), CHU Caen-Université de Caen Normandie ( UNICAEN ), Institut National du Cancer, INCA, Dynamique des capacités humaines et des conduites de santé ( EPSYLON ), Université Montpellier 1 ( UM1 ) -Université Paul-Valéry - Montpellier 3 ( UM3 ) -Université de Montpellier ( UM ), GRED French National Cancer Institute, EA Management des Organisations de Santé (EA MOS), École des Hautes Études en Santé Publique [EHESP] (EHESP)-PRES Sorbonne Paris Cité, Hôpital Corentin Celton [Issy-les-Moulineaux], Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), École des Hautes Études en Santé Publique [EHESP] (EHESP), Laboratoire Ethique Politique et Santé (EA 4569), Université Paris Descartes - Paris 5 (UPD5), Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - sciences sociales, politique, santé (IRIS), Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Sorbonne Paris Cité (USPC)-École des hautes études en sciences sociales (EHESS)-Université Paris 13 (UP13), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut médico-légal [CHU Caen] (IML), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Institut National du Cancer [Boulogne Billancourt] (INC), Dynamique des capacités humaines et des conduites de santé (EPSYLON), Université Montpellier 1 (UM1)-Université Paul-Valéry - Montpellier 3 (UPVM)-Université de Montpellier (UM), Duchange, Nathalie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), and Université Paris 13 (UP13)-École des hautes études en sciences sociales (EHESS)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris sciences et lettres (PSL)
- Subjects
Organized programme ,Health (social science) ,Debate ,Choice Behavior ,Information Background ,[ SDV.CAN ] Life Sciences [q-bio]/Cancer ,Breast cancer screening ,0302 clinical medicine ,Informed consent ,Information ,Mass Screening ,030212 general & internal medicine ,Early Detection of Cancer ,media_common ,Informed Consent ,medicine.diagnostic_test ,Health Policy ,[ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie ,Middle Aged ,3. Good health ,030220 oncology & carcinogenesis ,[ SDV.ETH ] Life Sciences [q-bio]/Ethics ,Female ,France ,Public Health ,Autonomy ,Mammography ,medicine.medical_specialty ,media_common.quotation_subject ,Breast Neoplasms ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,Morals ,Health(social science) ,Access to Information ,03 medical and health sciences ,[SDV.CAN] Life Sciences [q-bio]/Cancer ,Nursing ,medicine ,Humans ,Patient participation ,Aged ,Ethics ,Physician-Patient Relations ,business.industry ,Public health ,Beneficence ,Patient Acceptance of Health Care ,[SDV.ETH] Life Sciences [q-bio]/Ethics ,[SDV.ETH]Life Sciences [q-bio]/Ethics ,Issues, ethics and legal aspects ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,Philosophy of medicine ,Personal Autonomy ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Patient Participation ,business - Abstract
International audience; 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.
- Full Text
- View/download PDF