Abstract
Breast cancer is the most prevalent cancer among women and mammography screening programs are seen as a key strategy to reduce breast cancer mortality. In Germany, women are invited to the population-based mammography screening program between ages 50 to 69. It is still discussed whether the benefits of mammography screening outweigh its harms. Therefore, the concept of informed choice comprising knowledge, attitude and intention has gained importance. The objective of this observational study was to assess the proportion of informed choices among women invited to the German mammography screening program for the first time. A representative sample of 17,349 women aged 50 years from a sub-region of North Rhine Westphalia was invited to participate in a postal survey. Turkish immigrant women were oversampled. The effects of education level and migration status on informed choice and its components were assessed. 5,847 (33.7%) women responded to the postal questionnaire of which 4,113 were used for analyses. 31.5% of the women had sufficient knowledge. The proportion of sufficient knowledge was lower among immigrants and among women with low education levels. The proportion of women making informed choices was low (27.1%), with similar associations with education level and migration status. Women of low (OR 2.75; 95% CI 2.18–3.46) and medium education level (OR 1.49; 95% CI 1.27–1.75) were more likely to make an uninformed choice than women of high education level. Turkish immigrant women had the greatest odds for making an uninformed choice (OR 5.30, 95% CI 1.92–14.66) compared to non-immigrant women. Other immigrant women only had slightly greater odds for making an uninformed choice than non-immigrant women. As immigrant populations and women with low education level have been shown to have poor knowledge, they need special attention in measures to increase knowledge and thus informed choices.
Highlights
Population-based breast cancer screening programs have been implemented in many European countries in the last decades
The questionnaire we developed is based on existing instruments, qualitative Interviews with German and Turkish women and a qualitative study on factors related to mammography screening participation among Turkish women [22]
Note: data are given as percent; n = 3,601 a defined as informed choice b inconsistency between attitude and intentional mammography uptake doi:10.1371/journal.pone.0142316.t002
Summary
Population-based breast cancer screening programs have been implemented in many European countries in the last decades. In Germany, women aged 50 to 69 years are invited for a mammogram in a specialized center every two years [1]. The aims of such programs are to reduce mortality from breast cancer and improve outcomes through early detection and treatment [2]. The concept of informed choice competes with the goal of a high participation rate (at least 70 per cent to assure quality and effectiveness of the screening) [2], its fundamental importance is accepted by most stakeholders in Germany [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
