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.
This article summarises the pros and cons of cervical, breast
and colorectal cancer screening and discusses strategies for
implementing informed choice in practice.
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.
Cancer, along with cardiovascular disease, remains a major cause of death in Australians, despite considerable gains in cancer control over the past few decades.1 Cancer is the leading contributor to Australia’s total burden of disease and injury. It contributed 19% of total disability adjusted life years (DALY s) followed by cardiovascular disease (17%) and mental disorders (13%). (One DALY is equivalent to ‘one healthy year of life lost’ and attempts to take into account premature death and disability.)
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