Information media and decision support tools for cancer screening

Context: In France, breast cancer has been the most commonly diagnosed and the most lethal cancer in women. The risk-benefit ratio of organized breast cancer screening has been the focus of much scientific controversy, especially about overdiagnosis. A citizen conference and some scientific organizations have asked for a better education for women. The aim of this study was to analyze the numerous decision support tools and other information media, both in form and in substance. Methods: A review of the existing publications has been done by 4 researchers between 2006 and 2016. Original articles included, in French or in English, focused on information media or decision aid tools for organized screening without any restriction on the type of studies. Results: The 69 articles included in this review have shown that a better education of the patients was not related to an increase in the will to take part or in the actual participation in screening. The information media (pamphlet, video...) does not appear to have any influence on those ratios. The participants like having a discussion with a trained interviewer. In a third of the studies, the population was included on ethnic and social criteria. 8 studies focused on overdiagnosis. Conclusion: This review underlines the importance of repeated interviews, as a support for shared decision making. Specific interactions (such as patient navigator) could help to reduce social health inequalities. The patients should be informed about the current uncertainty regarding the ratio of overdiagnosis.