Table 3 Experts’ rationales for their stance on guidance and information provision to women regarding 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