title: Women's participation in breast cancer screening in France--an ethical approach.
abstract: BACKGROUND
  Breast cancer is a major public health challenge. Organized mammography screening (OS) is considered one way to reduce breast cancer mortality. EU recommendations prone mass deployment of OS, and back in 2004, France introduced a national OS programme for women aged 50-74 years. However, in 2012, participation rate was still just 52.7%, well short of the targeted 70% objective. In an effort to re-address the (in) efficiency of the programme, the French National Cancer Institute has drafted an expert-group review of the ethical issues surrounding breast cancer mammography screening.
  
  
  CONCLUSIONS
  Prompted by emerging debate over the efficiency of the screening scheme and its allied public information provision, we keynote the experts' report based on analysis of epidemiological data and participation rate from the public health authorities. The low coverage of the OS scheme may be partly explained by the fact that a significant number of women undergo mammography outside OS and thus outside OS criteria. These findings call for further thinking on (i) the ethical principles of beneficence and non-malfeasance underpinning this public health initiative, (ii) the reasons behind women's and professionals' behavior, and (iii) the need to analyze how information provision to women and the doctor-patient relationship need to evolve in response to scientific controversy over the risks and benefits of conducting mammographic screening.
  
  
  CONCLUSIONS
  This work calls for a reappraisal of the provision of screening programme information. We advocate a move to integrate the points sparking debate over the efficiency of the screening scheme to guarantee full transparency. The perspective is to strengthen the respect for autonomy allowing women to make an informed choice in their decision on whether or not to participate.
authors.affiliation: Assistance Publique Hôpitaux de Paris, Hôpital Universitaire Georges Pompidou Corentin-Celton, Université Paris Descartes, 92130 Issy-les-Moulineaux, France. gregoire.moutel@parisdescartes.fr.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Moutel
authors.forename: Nathalie
authors.initials: N
authors.lastname: Duchange
authors.forename: Sylviane
authors.initials: S
authors.lastname: Darquy
authors.forename: Sandrine
authors.initials: S
authors.lastname: de Montgolfier
authors.forename: Frédérique
authors.initials: F
authors.lastname: Papin-Lefebvre
authors.forename: Odile
authors.initials: O
authors.lastname: Jullian
authors.forename: Jérôme
authors.initials: J
authors.lastname: Viguier
authors.forename: Hélène
authors.initials: H
authors.lastname: Sancho-Garnier
mesh_terms: D022126:Access to Information / Q000941:ethics*; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D002755:Choice Behavior; D055088:Early Detection of Cancer; D005260:Female; D005602:France; D006801:Humans; D007258:Informed Consent; D008327:Mammography; D008403:Mass Screening / Q000941:ethics* / Q000379:methods; D008875:Middle Aged; D009014:Morals; D010342:Patient Acceptance of Health Care; D010358:Patient Participation; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D011634:Public Health