Women's Benefits and Harms Trade-Off in Breast Cancer Screening: Results from a French Discrete-Choice Experiment

Key Contextual Factors

• After fifteen years of the national breast cancer screening implementation, a controversy emerged these last years, mainly on the harms/benefits trade-offs and the effectiveness of using mammography for screening.
• French women have expressed a need for more information, especially about the risks and harms in the BC screening process (overdiagnosis and false-positive).
• For the first time in BC screening study, it has been decided to offer a neutral way for volunteer women, to try one’s hand at making a choice in BC screening matters, through this specific method of Discrete-Choice.

Key Components/Steps

Three steps in the Discrete Choice Experiment:

• Selecting attributes and levels (e.g: overdiagnosis risk, false-positive risk, number of screening tests, time spent traveling to the radiology center, etc.).
• Choosing an appropriate design for building the choice scenarios.
• Carrying out survey (sampling respondents and collecting data) and data analysis.

Main Impacts / Added Value

• The major challenge of the study was to assess the individual perception of benefits/harms balance for each woman.
• In using this method, researchers and institutions better understood the brakes and drivers of women participation in the BC screening program, and how individual perception vary from a woman to another (benefits/harms balance, social determinants, level of education, etc.).
• Furthermore, the study has highlighted the necessity of defining a screening policy offering a free and informed choice for all the women.

Lessons Learned

• The D-C method put under the lights the heterogeneous behaviors, limits and determinants towards BC screening. This heterogeneity is partly depending of the socio-economic level of women and their comprehension of disposable information (numeracy and literacy).
• Most of participants stated that identified risks of BC screening are acceptable regarding the estimated benefits.
• Study permitted to take an engagement for women, and offer them means to take a free and informed choice in doing BC screening, principally through decision-aids approaches to help women in benefit/harms trade-offs.

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