Improving the Breast Cancer Screening Program Through a Health Democracy Principle: a Citizen and Scientific Consultation

Key Contextual Factors

• In France, breast cancer is the leading cause of cancer mortality in women. After a past decade of the national breast cancer screening implementation, the program had to be evaluated and questioned in order to continuously improve.
• Aware of the aversion feeling from general population concerning the controversy (benefits/harms ratio), as well as the lack of general information in breast cancer, the French National Cancer Institute has been mandated by MoH and has setted up a scientific and citizen consultation, to give the floor to all the women and health professionals.

Key Components/Steps

• Creation of an independent scientific committee to discuss which topics must be evocated in the consultation
• Launch of a public website dedicated to the citizen & scientific consultation.
• Workshop and constitution of the “citizens’ conference”: A panel of women from diverse social origins, produced a collective view on what they think about the program and their expectations.
• Workshop and constitution of the “professionals’ conference”: A panel of health professionals, not experts in breast cancer but implicated in the program in their daily practice.
• Audition of experts and analysis of other contributions submitted.
• Drafting a joint contribution arising from the scientific committee.
• Public meeting of the citizen and scientific consultation closing (reporting results).
• Implementation of the Breast Cancer screening renovation’s plan; with new actions in public health, organization, research and communication.

Main Impacts / Added Value

• The main added value in using an independent and participatory process, permits to gather brakes straight from the public concerned by screening.
• By the mean of a citizen consultation, the ministry was able to take into account  the general population feeling concerning the need of a better information and transparency related to the benefits and harms trade-offs in breast cancer screening and to adapt the public policy.

Lessons Learned

• Gain in credibility thanks to the outsourcing process of doing a citizens’ consultation.
• Taking into account the needs of citizens, with neutrality.
• Benefits from the multifocal approach.
• Complete overhaul of the information’s book intended for women and health professionals.
• Current development of decision-aids(starting with the creation of a special website dedicated to the program).
• Improvement of the quality and the accessibility to the program.

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