Breast Cancer Screening: Navigating the Complexities of Informed Consent

BACKGROUND: Breast cancer ranks as a leading cause of death worldwide, however screening has become controversial in recent years due to new evidence suggesting the risks may outweigh the benefits. Whilst being the target of organised screening programmes, the average women overestimates both their own risk of breast cancer and the benefit gained from screening attendance. It is unclear whether a woman would make the same decision to participate if she was fully informed. This review aims to examine current evidence for the relationship between informed consent and screening participation rates. METHODS: A literature search was performed over 3 databases to find studies relating breast cancer screening, informed consent, and participation. 11 original studies and 4 systematic reviews were identified as relevant. Outcomes for knowledge/informed choice and resultant intention/attendance were extracted then evaluated. RESULTS: Results were diverse in regards to relationship. 4 of 8 original studies with an increase in knowledge/informed choice found a decrease in attendance/intention. The remaining 4 found no significant difference. Similarly, the systematic reviews found a decrease in 2 of 4, while the remaining found no change. On evaluation, follow up time was found to be a potential confounding factor. Studies measuring outcomes over multiple time periods found more significant differences at earlier recordings. This may indicate a relationship between increased knowledge/informed choice and decreased delay to attendance. CONCLUSIONS: This review highlights the need for healthcare providers to ensure that women are fully informed about the risks and benefits of screening. While some women may still choose to participate, others may opt out, raising questions on the balance of patient autonomy and provision of healthcare. Ultimately, it is the duty of healthcare providers to empower women with the knowledge they need to make informed decisions about their health. KEY MESSAGES: • Women may opt-out of breast cancer screening if fully informed about risks/benefits. Providers must empower patients to make informed decisions, while balancing effective healthcare and autonomy. • The ethical principle of patient autonomy requires informed consent for medical interventions. Empowering women with knowledge about may make them opt out, however this right is crucial to respect.