Towards a paradigm shift in cancer screening: informed citizens instead of greater participation

Policy on screening people for cancer poses a dilemma: should we aim for higher participation rates or for better informed citizens? The dilemma is that both cannot be had. A focus on informing citizens risks lowering participation rates, because well informed people may realise that for most cancers it is unclear whether the benefits of screening exceed its harms. Historically, screening policies opted for increasing participation and accordingly took measures that made people overestimate the benefits and underestimate the harms.1 But that is set to change, at least in Germany.

The goal of increasing participation rates has been moderately successful. For instance, German breast cancer screening campaigns set a goal of participation of 70% of eligible women and reached over 50%. Similarly, the NHS Breast Screening Programme in England aimed for an 80% participation rate and reached over 70%.2 But campaigns for this screening test and most other cancer screening tests have caused …