Consolidated principles for screening based on a systematic review and consensus process

Mark J. Dobrow; Victoria Hagens; Roger Chafe; Terrence Sullivan; Linda Rabeneck

doi:10.1503/cmaj.171154

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Principles for screening: too few concerns for informed consent?
alain braillon, Philippe Nicot and Cécile Bour

Posted on: 24 April 2018

Posted on: (24 April 2018)

Principles for screening: too few concerns for informed consent?
alain braillon, senior consultant, University hospital. 80000 Amiens. France. braillon.alain@gmail.com
Other Contributors:
Philippe Nicot, GP

Cécile Bour, Radiologist
Dobrow et al must be commended for their comprehensive but simple review of screening principles with three chapters: a) Disease/condition, b) Test/intervention; c) program/system.(1) The latter is too frequently overlooked despite screening is far more than a test for a disease, it should be first a public health program with quality insurance. Sadly, resources are a constraint. However, principle 9 “informed choice, promoting autonomy and protecting (participants) rights” is simple and cheap to implement.

Pictographs with absolute numbers (using a consistent denominator, such as/1000 screened), time frames and visuals employing the same scale for information on gains and losses of the options are evidence based.(2)The small kingdom of Belgium has been implementing this since 2013 for breast cancer screening. In contrast, the French National Cancer Institute , as other health agencies, flies in the face of ethics, refusing to provide such information despite serial public requests since 2012, even the most recent one supported by the main French consumers NGO.(3) Worse, this has been associated with: a) torture of the data to deny the overdiagnostic, also refusing scientific debate;(4) b) the inclusion of screening uptake in the 4P4 scheme with the legalization of an unbalanced information: “the general practitioner draws the patient’s attention to the benefits of (breast cancer) screening. . . produces positive information about screening. . . which naturally f...
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Dobrow et al must be commended for their comprehensive but simple review of screening principles with three chapters: a) Disease/condition, b) Test/intervention; c) program/system.(1) The latter is too frequently overlooked despite screening is far more than a test for a disease, it should be first a public health program with quality insurance. Sadly, resources are a constraint. However, principle 9 “informed choice, promoting autonomy and protecting (participants) rights” is simple and cheap to implement.

Pictographs with absolute numbers (using a consistent denominator, such as/1000 screened), time frames and visuals employing the same scale for information on gains and losses of the options are evidence based.(2)The small kingdom of Belgium has been implementing this since 2013 for breast cancer screening. In contrast, the French National Cancer Institute , as other health agencies, flies in the face of ethics, refusing to provide such information despite serial public requests since 2012, even the most recent one supported by the main French consumers NGO.(3) Worse, this has been associated with: a) torture of the data to deny the overdiagnostic, also refusing scientific debate;(4) b) the inclusion of screening uptake in the 4P4 scheme with the legalization of an unbalanced information: “the general practitioner draws the patient’s attention to the benefits of (breast cancer) screening. . . produces positive information about screening. . . which naturally falls within the scope of mere monitoring. . . in order to remove his patients’ reticence”.(5)

1 Dobrow MJ, Hagens V, Chafe R, Sullivan T, Rabeneck L. Consolidated principles for screening based on a systematic review and consensus process. CMAJ 2018;190:E422-E429.

2 Braillon A, Bewley S. Shared decision-making for cancer screening: Visual tools and a 4-Step Method. JAMA Intern Med. 2015;175:1862.

3 Collective. [Breast cancer. The National Cancer Institute provide women with incomplete and partial information on the advantages and disadvantages of organized breast cancer screening]. Que Chosir. 6 April 2016 Available at https://www.quechoisir.org/action-ufc-que-choisir-cancer-du-sein-l-inca-... Accessed 20 April 2018.

4 Braillon A, Bewley S. Why use Markov simulation models for estimating the effect of cancer screening policies when randomised controlled trials provide better evidence? Stat Methods Med Res.2012;21:217-8.

5 Braillon A, Nicot P Cancer screening and informed consent. A new French exception? Prev Med 2011;53:437
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Competing Interests: None declared.