. 2015 Oct 19;15:741. doi: 10.1186/s12885-015-1749-0

Table 3.

Experts’ rationales for their stance on guidance and information provision to women regarding breast screening

Guiding women towards breast screening
FOR
● Maximises screening participation^a
● Saves lives^a
● Women will have more treatment options^a
● Overall, screening delivers more benefits than harms to the population^a
● Overdiagnosis is not a harm
● Providing guidance about good health is a government public health responsibility
● You don’t want people to make decisions in public health, you just want them to follow advice
● Expecting consumers to make their own informed choice is unfair and unrealistic because the evidence is so complicated
● (Some) people want to be told what to do
AGAINST
● Individuals should be free to make their own decisions^a
● Personal autonomy is important^a
● Harm:benefit ratio is equivocal so screening should be an individual choice, not a government-promoted activity^a
● Screening affects only the individual concerned, so there is no community-benefit argument to justify promotion of screening
● Others may not have the best interests of the individual consumer at heart
● Consumers tend to be better than policy makers at remembering to consider screening harms as well as benefits, so judgements about screening should be left to consumers
● The harms of breast screening are greater than the benefits
Limiting consumer information on overdiagnosis
FOR
● Maximises screening participation^a
● Calling overdiagnosis a “harm” is just one (mis)interpretation of the facts
● Women don’t consider overdiagnosis a harm; main harms that women care about are: pain, hassles of parking and making appointments, radiation, breast damage, anxiety about recalls
● Population based information on overdiagnosis is not applicable to individuals
● The real problem is not overdiagnosis but overtreatment
AGAINST
● People should know what they are signing up for when they participate in screening^a
● Providing information enables informed decision making^a
● Informed decision making is particularly important for breast screening because there are some downsides^a
● Providing full information is a professional responsibility
● (Some) women want full information

^avery strongly/frequently expressed reasons