How is informed decision-making about breast cancer screening addressed in Europe? An international survey of 28 countries

The aim of this study was to develop a typology of approaches towards informed decision-making (IFD) about mammography screening in Europe. All countries collaborating in the European Commission Initiative on Breast Cancer were approached to participate. Experts from 28 European countries responded to a web-based survey providing data on key organisational and policy characteristics of breast screening at the national or regional level. A total of 35 responses were received including data from regionally organised breast screening in several countries. 27 respondents, covering 21 countries, reported the existence of a policy towards IFD and stated that they communicated to women about the benefit and risks. Few countries had attempted to measure the proportion of women making an informed choice. A cluster analysis of the survey responses allowed to identify three categories: countries in a confirmation phase who have adopted a policy specific to mammography screening; countries in an implementation phase with generic polices and limited administrative support dedicated yet to IFD; and countries in a decision phase who are deliberating how to address IFD. To the best of our knowledge,this study is the first to investigate the key policy and organisational characteristics of approaches taken to facilitate IFD in Europe. The results demonstrate a broad adoption of the principle of enabling IFD but indicate heterogeneity of implementation