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

From: The role of communication in breast cancer screening: a qualitative study with Australian experts

Guiding women towards breast screening
FOR
Maximises screening participationa
Saves livesa
Women will have more treatment optionsa
Overall, screening delivers more benefits than harms to the populationa
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 decisionsa
Personal autonomy is importanta
Harm:benefit ratio is equivocal so screening should be an individual choice, not a government-promoted activitya
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 participationa
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 screeninga
Providing information enables informed decision makinga
Informed decision making is particularly important for breast screening because there are some downsidesa
Providing full information is a professional responsibility
(Some) women want full information
  1. avery strongly/frequently expressed reasons