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Letters

Principles for screening: Too few concerns for informed consent and shared decision-making?

Alain Braillon, Philippe Nicot and Cécile Bour
CMAJ September 17, 2018 190 (37) E1115; DOI: https://doi.org/10.1503/cmaj.69766
Alain Braillon
Senior consultant, University Hospital, Amiens, France
MD
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Philippe Nicot
Family physician, Panazol, France
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Cécile Bour
Radiologist, Clouange, France
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Dobrow and colleagues must be commended for their comprehensive but simple review of screening principles in three sections: disease/condition, test/intervention and program/system.1 The latter is frequently overlooked. Screening is far more than a test for a disease; it should be considered a public health program with quality assurance built in. Sadly, resources are a constraint for implementing these principles. However, principle 9 “informed choice, promoting autonomy and protecting [participants’] rights” is simple and inexpensive to implement.1

There is good evidence that 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 can contribute to shared decision-making.2 Belgium has been using pictographs since 2013 for breast cancer screening. In contrast, the National Cancer Institute in France, and other health agencies, flying in the face of ethics, has not provided such information to patients despite many public requests since 2012, with the most recent one supported by the main consumers nongovernmental organization in France.3 Worse, this has been combined with data torture to deny the possibility of overdiagnosis, suppression of scientific debate on breast cancer screening4 and the inclusion of screening uptake in France’s 4P4 quality improvement scheme that promotes the propagation of unbalanced information for patients: “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

Footnotes

  • Competing interests: None declared.

References

  1. ↵
    1. Dobrow MJ,
    2. Hagens V,
    3. Chafe R,
    4. et al
    . Consolidated principles for screening based on a systematic review and consensus process. CMAJ 2018; 190:E422–9.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Braillon A,
    2. Bewley S
    . Shared decision-making for cancer screening: visual tools and a 4-step method. JAMA Intern Med 2015;175:1862.
    OpenUrl
  3. ↵
    Cancer du sein — L’INC a fourni aux femmes une information incomplète et partiale sur les avantages et les inconvénients à suivre le dépistage organisé. Que Chosir; 2018 Apr. 6. Available: www.quechoisir.org/action-ufc-que-choisir-cancer-du-sein-l-inca-fournit-aux-femmes-une-information-incomplete-et-partiale-sur-les-avantages-et-les-inconvenients-a-suivre-le-depistage-organise-n53673/ (accessed 2018 Apr. 20).
  4. ↵
    1. Braillon A,
    2. 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.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Braillon A,
    2. Nicot P
    . Cancer screening and informed consent. A new French exception? Prev Med 2011;53:437.
    OpenUrlPubMed
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Canadian Medical Association Journal: 190 (37)
CMAJ
Vol. 190, Issue 37
17 Sep 2018
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Principles for screening: Too few concerns for informed consent and shared decision-making?
Alain Braillon, Philippe Nicot, Cécile Bour
CMAJ Sep 2018, 190 (37) E1115; DOI: 10.1503/cmaj.69766

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Principles for screening: Too few concerns for informed consent and shared decision-making?
Alain Braillon, Philippe Nicot, Cécile Bour
CMAJ Sep 2018, 190 (37) E1115; DOI: 10.1503/cmaj.69766
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