title: Participation rate or informed choice? Rethinking the European key performance indicators for mammography screening.
abstract: Despite the intensive controversies about the likelihood of benefits and harms of mammography screening almost all experts conclude that the choice to screen or not to screen needs to be made by the individual patient who is adequately informed. However, the "European guideline for quality assurance in breast cancer screening and diagnosis" specifies a participation rate of 70% as the key performance indicator for mammography screening. This paper argues that neither the existing evidence on benefits and harms, nor survey research with women, nor compliance rates in clinical trials, nor cost-effectiveness ratios justify participation rates as a reasonable performance indicator for preference-sensitive condition such as mammography screening. In contrast, an informed choice rate would be more reasonable. Further research needs to address the practical challenges in assessing informed choice rates.
authors: Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany. Electronic address: strech.daniel@mh-hannover.de.
authors: Daniel
authors: D
authors: Strech
mesh_terms: D001943:Breast Neoplasms / Q000517:prevention & control; D002755:Choice Behavior; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*
keywords: Ethics; Informed choice; Mammography screening; Participation rate; Performance indicator; Preference sensitive condition