Decision-making about mammographic screening: pursuing informed choice

For decades, persuasive techniques have been used to communicate to women about breast cancer screening with the aim of maximizing screening uptake. However, more recently this has shifted to an approach which recognizes that it is important for women to be aware of harms, such as overdiagnosis, as well as benefits of breast screening. There is a lack of consensus in the literature around whether benefits clearly outweigh harms for population-based breast cancer screening. In light of this, the gold standard for communication about breast cancer screening is now to try and support informed decision-making - that is, to help women understand both the advantages and disadvantages of screening, allowing them to make individual decisions about their screening participation that reflect their informed preferences. In this review, we summarize relevant research to identify theoretical and practical aspects of improving communication and decision-making about breast cancer screening, and discuss future implications.