Breast cancer in Canada: to screen or not to screen?
Lomas (1988) and Sabatier (1987) have suggested models by which to examine the roles that values, scientific knowledge, institutions, and the learning process play in the formulation of both national and clinical health-care policies. Utilizing their frameworks, this article offers an explanation for the development of high-volume screening mammography policies in Canada, despite the suggested inefficacy of screening technologies for 'unavoidable' illnesses such as carcinoma in the breast. The preliminary results of Canada's National Breast Screening Study further complicate this tissue. Inappropriate framing of the 'problem' in the policy-making process, by actors highly influenced by societal values and scientific evidence, is identified as the reason for present and planned policies and practices contradicting the first principles of health-policy analysis.
McMaster University, Hamilton, Ontario.
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Taylor
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Little
D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D002170:Canada / Q000453:epidemiology; D005260:Female; D006291:Health Policy; D006801:Humans; D008327:Mammography / Q000592:standards / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011050:Policy Making