[Breast cancer screening program in France: for optimization of the information]
F Papin-Lefebvre1, G Moutel2, N Duchange3
1U1086 Inserm « cancers et préventions », centre François-Baclesse, avenue du Général-Harris, BP 5026, 14076 Caen cedex 5, France; Institut médico-légal, hôpital Côte-de-Nacre, CHU de Caen, 14033 Caen cedex, France; EA4569, laboratoire d'éthique médicale et médecine légale, université Paris Descartes, Paris, France.
Background:
Based on international and national recommendations, organized breast cancer screening in France raises questions of medical ethics built around the key concepts of individual autonomy and public health policy. Because of the evolving knowledge, professionals and institutions involved in the program must review the ethical values associated with this medical practice.
Methods:
The ethical aspects of organized breast cancer screening were studied. In response to newly acquired knowledge highlighted by a review of texts governing this practice in France, proposals for changes resulting from reflections of a working group coordinated by the National Cancer Institute are presented.
Results:
Ethical issues raised by screening must find expression in the general principles of the program's organization: acceptability of screening, efficiency, adverse effects, equity of access, free care…, but also at different stages of the procedure: information delivery, first and second invitations, refusal of further diagnostic investigation…
Conclusion:
A better match between breast cancer screening and recently developed knowledge requires optimal information delivery to women targeted by the program as well as a stronger role for the referring healthcare professional.
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