Cancer screening Pros, cons, choice, and the patient

Background Cancer is a major cause of disability and death in Australia, with three government funded screening programs now in place nationally. As cancer screening tests are performed on healthy asymptomatic members within the community, one needs to consider whether the potential gains will outweigh possible harms. There are challenges for both practitioners and consumers in communicating about screening in practice. Objective This article summarises the pros and cons of cervical, breast and colorectal cancer screening and discusses strategies for implementing informed choice in practice. Discussion Cancer screening has often focused on promoting maximum participation. All consumers should have access to balanced information about the pros and cons of screening, and there is now evidence from Australian studies of evidence based decision aids that being informed does not impact on participation rates. For some, this will mean 'accepting the offer' of the screening program and should include an open explanation and discussion of the basis for the recommendation or offer; encourage and facilitate an individual assessment of the recommendation or offer (including consideration of the potential bias and trustworthiness of those making it and of its personal relevance); provide or facilitate access to further information if that is required; and acknowledge that the recommendation or offer might reasonably be refused. Others will prefer to 'analyse and choose' from more detailed information such as decision aids. Tools for practitioners and consumers should mirror this two tiered approach and facilitate a balanced approach to cancer screening in practice.