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52 A collective approach to recommendations for de-implementation or reform of a national screening program. A case study from the french civic and scientific inquiry into breast cancer screening
  1. Alexandra Barratt1,
  2. Karsten Juhl Jørgensen2,
  3. Philippe Autier3
  1. 1Wiser Healthcare, University of Sydney, Australia
  2. 2Nordic Cochrane Centre, Copenhagen, Denmark
  3. 3International Prevention Research Centre, Lyon, France


Objectives In October 2016 the French Minister of Health released the report of an independent inquiry into mammography screening, presenting two options for the future: end the national breast screening program, or end the current program and put in place a radically reformed program. Our objective was to critically analyse the report and the process that led to it.

Method In September 2015, the Minister of Health ordered a civil and scientific inquiry, overseen by an independent committee of leading health (oncology, general medicine, epidemiology, public health) and social science professionals (anthropology, law, economics, history of science and bioethics), all free of ties to breast screening. As well as evidence reviews on specific questions, two substantial consultations were held: a civil consultation with a group of 27 women from different regions and diverse socio-economic groups, and a parallel consultation with a group of 19 independent health professionals. Each of these in-depth consultations took place over 5 days.

Results The citizen consultation recommended against keeping the program as currently implemented. The health professionals consultation recommended continuing the program, but with major reforms. The steering committee itself found an unexpectedly intense scientific controversy about mammography screening, noting limited evidence on key breast screening outcomes, and incomplete knowledge of the natural history of breast cancer. In its final report, the steering committee recommended that if the program were reformed rather than ended, there was a need for neutral, complete information; a research program into the natural history of breast cancer(s); improved program evaluation; an end to screening average risk women under 50 years of age.

Conclusions The French inquiry is strikingly different from other recommendation panels (eg USPSTF, American Cancer Society, International Agency for Research on Cancer) in process and result. Panels rarely seek the values and preferences of citizens in formulating recommendations yet screening impacts the lives of asymptomatic citizens. That the French inquiry included perspectives of citizens and unconflicted professionals may explain the difference in outcome. Seeking informed citizens’ views and preferences through in-depth, community deliberations can enable meaningful information sharing and exchange of views between citizens of diverse background. Such approaches may be useful to inform and support screening de-implementation processes.

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