9 Is the socio-cultural environment favorable to women making an informed decision regarding breast cancer screening in France?

Abstract

<h3></h3> Each woman should be able to freely decide whether or not to participate in breast cancer screening programmes, after receiving information on the benefits and risks of screening, based on the latest medical knowledge from EBM studies. Recent scientific data all point in the same direction: the benefit from screening for breast cancer is small and uncertain, while harms are well demonstrated. However, many strategies have been deployed to encourage women to be screened. <h3>Objective</h3> In this context, are women able to make an informed choice? <h3>Methods</h3> We have listed the influencing techniques that come into play empirically, based on our personal experiences in daily medical practice, but also through the ‘contact page’ of our Cancer Rose medical information website, which receives multiple testimonials and requests for information. <h3>Results</h3> These influencing techniques are based on: 1- Communication methods ‘Octobre Rose’ campaigns with slogans more advertising than informative The INCa and League against Cancer campaigns, certainly less ‘aggressive’ than a few years ago, but nevertheless biased, highlighting the benefits in an exaggerated manner while ignoring or minimizing the risks and never giving a voice to critics. Programmes and reality shows, highlighting ‘cancer survivors’. The influence of women’s entourage and societal messages. The inactivity and self-censorship of the media. 2- Financing The National healthcare system covers organized screening for breast cancer, implying its usefulness in the mind of the consumer. This funding leads women to believe that screening is mandatory General Practitioners receive remuneration based on the percentage of women who have been screened for breast cancer in their clientele. And this, despite the opposition of their representative bodies. This manoeuvre obviously aims to lead General Practionners to promote screening rather than to inform women in an unbiased manner. 3- Registration in the law: Decree of September 29, 2006 relating to cancer screening programs, updated however and less incentive. <h3>Discussion</h3> The final decision of each woman whether or not to participate in screening programmes seems to depend largely on personal history, contacts, friends, experience and history, women’s vision of society, medical incentive and advertising, societal messages, all of which can influence women in a more emotional than reasoned approach. In France, the 2016 citizen consultation on breast cancer screening required, on the subject of information, the design of decision making tools. However, no French national agency has tackled this task: neither INCa, Santé Publique France, nor the High Authority for Health or even the main associations fighting against cancer(ARC, Ligue contre le Cancer). <h3>Conclusion</h3> The current socio-cultural environment in France still largely encourages women to participate in screening programmes. Societal and even medical beliefs and convictions, supported by government attempts to meet so-called ‘public health’ objectives are all obstacles which prevent women from being objectively advised and deprive them of serene decision-making. It is important that international groups that are concerned about overdiagnosis and overtreatment get involved in collective public actions aimed at promoting honest information for women, as a counterpoint to ‘Pink’ campaigns.