title: Breast cancer screening controversy: too much or not enough?
abstract: The Cochrane analysis exploring the risk/benefit ratio of breast cancer screening resulted in a controversy worldwide spread by the mass media. Our survey sought to assess the impact of this controversy in terms of breast cancer screening awareness and attendance. A nationwide observational study, recorded in the EDIFICE iterative surveys, with a representative sample of 451 women aged 40-75 years, living in France, was carried out in the 3 months after the start of the controversy in January 2013. Of the 405 women with no personal history of cancer, 69 (17%) declared having heard of the controversy (aware group). Women remembering the controversy were more likely to belong to higher socioprofessional categories and to have a higher level of education. The most frequently remembered issues were overdiagnosis (38%), unreliability (16%) and radiation risk (9%). Compared with women who were unaware of the controversy, the aware group knew more about the limits of breast cancer screening (undiagnosed cancers, 20 vs. 7%, P<0.05 and risk of false positives, 20 vs. 2%, P<0.05) and were more likely to change their opinion for the worse over the mass media debate (8.7 vs. 1.2%, P<0.05). Nevertheless, only 1% of the aware-group declared their intention to subsequently undergo screening less frequently. The low impact of the controversy on the behaviour of women with respect to screening suggests that it should not be seen as a threat to screening attendance rates, but more as an opportunity to improve awareness.
authors.affiliation: aDepartment of Medical Oncology, Jean Minjoz University Hospital, Inserm U645, Besançon bCoordination Center for Cancer Screening, Bretonneau University Hospital, Tours cKantar Health, Montrouge dDepartment of Oncology and Hematology, Paul-Brousse University Hospital, Inserm U1004, Villejuif eLéon Bérard Cancer Centre, Lyon fPorte de Saint-Cloud Clinic, Boulogne-Billancourt gRoche, Boulogne-Billancourt hCancer Control Department, Paoli-Calmettes Institute iAix Marseille University, UMR_S912, IRD jINSERM, UMR912 (SESSTIM), Marseille, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pivot
authors.forename: Jérôme
authors.initials: J
authors.lastname: Viguier
authors.forename: Chantal
authors.initials: C
authors.lastname: Touboul
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Morère
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Blay
authors.forename: Yvan
authors.initials: Y
authors.lastname: Coscas
authors.forename: Christine
authors.initials: C
authors.lastname: Lhomel
authors.forename: François
authors.initials: F
authors.lastname: Eisinger
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D055088:Early Detection of Cancer / Q000639:trends*; D005260:Female; D005602:France / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys / Q000379:methods / Q000639:trends*; D006801:Humans; D008327:Mammography / Q000639:trends*; D008875:Middle Aged; D013997:Time Factors