BACKGROUND: Mammography screening has generated considerable professional and public debate. In this study, we investigate whether women receive sufficient information about the benefits and disadvantages of the Norwegian Breast Cancer Screening Program to enable them to make informed, independent choices. MATERIAL AND METHOD: Informational material from the Norwegian Breast Cancer Screening Program for 1996, 2003, 2009 and 2017 was analysed and compared with information from the independent inquiry into the mammography screening programme headed by the Research Council of Norway. The criteria that are essential in order to make informed choices are as follows: benefit (absolute and relative reduction in mortality), disadvantages (false-positive results, overdiagnosis, overtreatment and anxiety), implementation (following invitation, recall, and findings requiring treatment), and limitations (interval cancer). RESULTS: Information provided to women has significantly improved from 1996 to 2017. Nevertheless, the information in 2017 lacks important details regarding the disadvantages of screening, such as overdiagnosis and overtreatment. INTERPRETATION: The Norwegian Breast Cancer Screening Program does not provide sufficient information for women to be able to make informed, independent choices. Women are nudged to participate by prescheduled appointments, and the information is insufficiently balanced and nuanced.
BACKGROUND: Mammography screening has generated considerable professional and public debate. In this study, we investigate whether women receive sufficient information about the benefits and disadvantages of the Norwegian Breast Cancer Screening Program to enable them to make informed, independent choices. MATERIAL AND METHOD: Informational material from the Norwegian Breast Cancer Screening Program for 1996, 2003, 2009 and 2017 was analysed and compared with information from the independent inquiry into the mammography screening programme headed by the Research Council of Norway. The criteria that are essential in order to make informed choices are as follows: benefit (absolute and relative reduction in mortality), disadvantages (false-positive results, overdiagnosis, overtreatment and anxiety), implementation (following invitation, recall, and findings requiring treatment), and limitations (interval cancer). RESULTS: Information provided to women has significantly improved from 1996 to 2017. Nevertheless, the information in 2017 lacks important details regarding the disadvantages of screening, such as overdiagnosis and overtreatment. INTERPRETATION: The Norwegian Breast Cancer Screening Program does not provide sufficient information for women to be able to make informed, independent choices. Women are nudged to participate by prescheduled appointments, and the information is insufficiently balanced and nuanced.
Authors: Andrew D Oxman; Atle Fretheim; Simon Lewin; Signe Flottorp; Claire Glenton; Arnfinn Helleve; Didrik Frimann Vestrheim; Bjørn Gunnar Iversen; Sarah E Rosenbaum Journal: Health Res Policy Syst Date: 2022-03-05