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Published in: BMC Women's Health 1/2018

Open Access 01-12-2018 | Debate

Towards equity in organised cancer screening: the case of cervical cancer screening in France

Authors: Sylviane Darquy, Grégoire Moutel, Odile Jullian, Stéphanie Barré, Nathalie Duchange

Published in: BMC Women's Health | Issue 1/2018

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Abstract

Background

The French national cancer institute (INCa) conducted a series of studies to assist decision-making in view of the implementation of organised cervical cancer screening that will be launched in 2018. The programme will concern all women aged 25–65 and targeted interventions will be developed for underscreened populations. This is an evolution from an equality-based approach to a step-by-step strategy of equity aiming to tackle health cancer inequalities that are avoidable and represents unfair differences. Here we present the work of the expert-group in ethics drafted by INCa to review the ethical issues prior to the programme implementation.

Discussion

We discuss the value of such a strategy and presents reflections with regard to issues of stigmatization, respect for individual freedom and autonomy. Indeed, the balance has to be found between the search for beneficence and the potential occurrence of perverse effects, which should be considered with particular attention.

Conclusion

Moving toward an equity-oriented policy under a strategy of proportionate universalism faces a number of challenges, thus an overview of ethics and social sciences must be an integral part of the process.
Literature
1.
go back to reference Austoker J. Cancer prevention in primary care. Screening for cervical cancer. BMJ. 1994;309:241–8.CrossRef Austoker J. Cancer prevention in primary care. Screening for cervical cancer. BMJ. 1994;309:241–8.CrossRef
2.
go back to reference Chamberlain J. Reasons that some screening programmes fail to control cervical cancer. IARC Sci Publ. 1986;76:161–8. Chamberlain J. Reasons that some screening programmes fail to control cervical cancer. IARC Sci Publ. 1986;76:161–8.
3.
go back to reference Hakama M. Effect of population screening for carcinoma of the uterine cervix in Finland. Maturitas. 1985;7:3–10.CrossRef Hakama M. Effect of population screening for carcinoma of the uterine cervix in Finland. Maturitas. 1985;7:3–10.CrossRef
4.
go back to reference ICRF Coordinating Committee on Cervical Screening. Organisation of a programme for cervical cancer screening. Br Med J. 1984;289:894–5.CrossRef ICRF Coordinating Committee on Cervical Screening. Organisation of a programme for cervical cancer screening. Br Med J. 1984;289:894–5.CrossRef
5.
go back to reference Johannesson G, Geirsson G, Day N, Tulinius H. Screening for cancer of the uterine cervix in Iceland 1965--1978. Acta Obstet et Gynecol Scand. 1982;61:199–203.CrossRef Johannesson G, Geirsson G, Day N, Tulinius H. Screening for cancer of the uterine cervix in Iceland 1965--1978. Acta Obstet et Gynecol Scand. 1982;61:199–203.CrossRef
6.
go back to reference Madlensky L, Goel V, Polzer J, Ashbury FD. Assessing the evidence for organised cancer screening programmes. Eur J Cancer. 2003;39:1648–53.CrossRef Madlensky L, Goel V, Polzer J, Ashbury FD. Assessing the evidence for organised cancer screening programmes. Eur J Cancer. 2003;39:1648–53.CrossRef
7.
go back to reference Miller AB. Screening for cancer: state of the art and prospects for the future. World J Surg. 1989;13:79–83.CrossRef Miller AB. Screening for cancer: state of the art and prospects for the future. World J Surg. 1989;13:79–83.CrossRef
8.
go back to reference Nygård M. Screening for cervical cancer: when theory meets reality. BMC Cancer. 2011;11:240.CrossRef Nygård M. Screening for cervical cancer: when theory meets reality. BMC Cancer. 2011;11:240.CrossRef
9.
go back to reference Basu P, Ponti A, Anttila A, Ronco G, Senore C, Vale DB, et al. Status of implementation and organization of cancer screening in the European Union member states-summary results from the second European screening report. Int J Cancer. 2018;142:44–56.CrossRef Basu P, Ponti A, Anttila A, Ronco G, Senore C, Vale DB, et al. Status of implementation and organization of cancer screening in the European Union member states-summary results from the second European screening report. Int J Cancer. 2018;142:44–56.CrossRef
10.
go back to reference Minozzi S, Armaroli P, Espina C, Villain P, Wiseman M, Schüz J, et al. European code against Cancer 4th edition: process of reviewing the scientific evidence and revising the recommendations. Cancer Epidemiol. 2015;39:S11–9.CrossRef Minozzi S, Armaroli P, Espina C, Villain P, Wiseman M, Schüz J, et al. European code against Cancer 4th edition: process of reviewing the scientific evidence and revising the recommendations. Cancer Epidemiol. 2015;39:S11–9.CrossRef
11.
go back to reference Binder-Foucard F, Bossard N, Delafosse P, Belot A, Woronoff AS, Remontet L, et al. Cancer incidence and mortality in France over the 1980-2012 period: solid tumors. Rev Epidemiolt Sante Publique. 2014;62:95–108.CrossRef Binder-Foucard F, Bossard N, Delafosse P, Belot A, Woronoff AS, Remontet L, et al. Cancer incidence and mortality in France over the 1980-2012 period: solid tumors. Rev Epidemiolt Sante Publique. 2014;62:95–108.CrossRef
12.
go back to reference Hamers FF, Duport N, Beltzer N. Population-based organized cervical cancer screening pilot program in France. Eur J Canc Prev. 2017; Epub ahead of print. Hamers FF, Duport N, Beltzer N. Population-based organized cervical cancer screening pilot program in France. Eur J Canc Prev. 2017; Epub ahead of print.
13.
go back to reference Barré S, Massetti M, Leleu H, Catajar N. de bels F (2017). Characteristics of french women who fail to undergo regular pap smears for cervical cancer screening. BEH. 2017;2–3:39–47. Barré S, Massetti M, Leleu H, Catajar N. de bels F (2017). Characteristics of french women who fail to undergo regular pap smears for cervical cancer screening. BEH. 2017;2–3:39–47.
14.
go back to reference Barré S, Massetti M, Leleu H, de Bels F. Organised screening for cervical cancer in France: a cost-effectiveness assessment. BMJ Open. 2017;7:e014626.CrossRef Barré S, Massetti M, Leleu H, de Bels F. Organised screening for cervical cancer in France: a cost-effectiveness assessment. BMJ Open. 2017;7:e014626.CrossRef
17.
go back to reference Marmot M, Bell R. Fair society, healthy lives. Public Health. 2012;126(Suppl 1):S4–S10.CrossRef Marmot M, Bell R. Fair society, healthy lives. Public Health. 2012;126(Suppl 1):S4–S10.CrossRef
18.
go back to reference Benach J, Malmusi D, Yasui Y, Martínez JM. A new typology of policies to tackle health inequalities and scenarios of impact based on Rose’s population approach. J Epidemiol Community Health. 2013;67:286–91.CrossRef Benach J, Malmusi D, Yasui Y, Martínez JM. A new typology of policies to tackle health inequalities and scenarios of impact based on Rose’s population approach. J Epidemiol Community Health. 2013;67:286–91.CrossRef
19.
go back to reference Deandrea S, Molina-Barceló A, Uluturk A, Moreno J, Neamtiu L, Peiró-Pérez R, et al. Presence, characteristics and equity of access to breast cancer screening programmes in 27 European countries in 2010 and 2014. Results from an international survey. Prev Med. 2016;91:250–63.CrossRef Deandrea S, Molina-Barceló A, Uluturk A, Moreno J, Neamtiu L, Peiró-Pérez R, et al. Presence, characteristics and equity of access to breast cancer screening programmes in 27 European countries in 2010 and 2014. Results from an international survey. Prev Med. 2016;91:250–63.CrossRef
20.
go back to reference Carey G, Crammond B, De Leeuw E. Towards health equity: a framework for theapplication of proportionate universalism. Int J Equity Health. 2015;14:81.CrossRef Carey G, Crammond B, De Leeuw E. Towards health equity: a framework for theapplication of proportionate universalism. Int J Equity Health. 2015;14:81.CrossRef
22.
go back to reference Singer A, Ashfaq Khan A. Cervical cancer screening: an exemplar of a population screening programme and cervical cancer prevention. In: Eeles RA, Berg CD, Tobias S, editors. In Cancer Prevention and Screening: Concepts, Principles and Controversies. Willey-Blackwell; 2018. Singer A, Ashfaq Khan A. Cervical cancer screening: an exemplar of a population screening programme and cervical cancer prevention. In: Eeles RA, Berg CD, Tobias S, editors. In Cancer Prevention and Screening: Concepts, Principles and Controversies. Willey-Blackwell; 2018.
24.
go back to reference Marlow LAV, Chorley AJ, Haddrell J, Ferrer R, Waller J. Understanding the heterogeneity of cervical cancer screening non-participants: data from a national sample of British women. Eur J Cancer. 2017;80:30–8.CrossRef Marlow LAV, Chorley AJ, Haddrell J, Ferrer R, Waller J. Understanding the heterogeneity of cervical cancer screening non-participants: data from a national sample of British women. Eur J Cancer. 2017;80:30–8.CrossRef
25.
go back to reference Menvielle G, Richard J-B, Ringa V, Dray-Spira R, Beck F. To what extent is women’s economic situation associated with cancer screening uptake when nationwide screening exists? A study of breast and cervical cancer screening in France in 2010. Cancer Causes Control. 2014;25:977–83.CrossRef Menvielle G, Richard J-B, Ringa V, Dray-Spira R, Beck F. To what extent is women’s economic situation associated with cancer screening uptake when nationwide screening exists? A study of breast and cervical cancer screening in France in 2010. Cancer Causes Control. 2014;25:977–83.CrossRef
26.
go back to reference Rawls J. A theory of justice. Cambridge, Mass: The Belknap Press of Harvard University; 1971. Rawls J. A theory of justice. Cambridge, Mass: The Belknap Press of Harvard University; 1971.
27.
go back to reference Marmot M. Social justice, epidemiology and health inequalities. Eur J Epidemiol. 2017;32:537–46.CrossRef Marmot M. Social justice, epidemiology and health inequalities. Eur J Epidemiol. 2017;32:537–46.CrossRef
29.
go back to reference Hope KA, Moss E, Redman CWE, Sherman SM. Psycho-social influences upon older women’s decision to attend cervical screening: a review of current evidence. Prev Med. 2017;101:60–6.CrossRef Hope KA, Moss E, Redman CWE, Sherman SM. Psycho-social influences upon older women’s decision to attend cervical screening: a review of current evidence. Prev Med. 2017;101:60–6.CrossRef
30.
go back to reference Curmi C, Peters K, Salamonson Y. Lesbians’ attitudes and practices of cervical cancer screening: a qualitative study. BMC Womens Health. 2014;14:153.CrossRef Curmi C, Peters K, Salamonson Y. Lesbians’ attitudes and practices of cervical cancer screening: a qualitative study. BMC Womens Health. 2014;14:153.CrossRef
31.
go back to reference Huo D, Anderson D, Palmer JR, Herbst AL. Incidence rates and risks of diethylstilbestrol-related clear-cell adenocarcinoma of the vagina and cervix: update after 40-year follow-up. Gynecol Oncol. 2017;146:566–71.CrossRef Huo D, Anderson D, Palmer JR, Herbst AL. Incidence rates and risks of diethylstilbestrol-related clear-cell adenocarcinoma of the vagina and cervix: update after 40-year follow-up. Gynecol Oncol. 2017;146:566–71.CrossRef
32.
go back to reference Massé R. Stigmatisation sociale et santé publique : les enjeux éthiques. La Santé de L’homme. 2012;419:9–12. Massé R. Stigmatisation sociale et santé publique : les enjeux éthiques. La Santé de L’homme. 2012;419:9–12.
33.
go back to reference Bayer R. Stigma and the ethics of public health: not can we but should we. Soc Sci Med. 2008;67:463–72.CrossRef Bayer R. Stigma and the ethics of public health: not can we but should we. Soc Sci Med. 2008;67:463–72.CrossRef
34.
go back to reference Comité Consulatif National d’Ethique pour les Sciences de la Vie et de la Santé. Avis sur le dépistage de la tuberculose et la vaccination par le BCG. In: CCNE Avis n°92; 2006. Comité Consulatif National d’Ethique pour les Sciences de la Vie et de la Santé. Avis sur le dépistage de la tuberculose et la vaccination par le BCG. In: CCNE Avis n°92; 2006.
35.
go back to reference Ward JK, Colgrove J, Verger P. Why France is making eight new vaccines mandatory. Vaccine. 2018;36:1801–3.CrossRef Ward JK, Colgrove J, Verger P. Why France is making eight new vaccines mandatory. Vaccine. 2018;36:1801–3.CrossRef
36.
go back to reference Parker L, Carter S, Williams J, Pickles K, Barratt A. Avoiding harm and supporting autonomy are under-prioritised in cancer-screening policies and practices. Eur J Cancer. 2017;85:1–5.CrossRef Parker L, Carter S, Williams J, Pickles K, Barratt A. Avoiding harm and supporting autonomy are under-prioritised in cancer-screening policies and practices. Eur J Cancer. 2017;85:1–5.CrossRef
37.
go back to reference Moutel G, Duchange N, Darquy S, de Montgolfier S, Papin-Lefebvre F, Jullian O, Viguier J, Sancho-Garnier H. GRED French National Cancer Institute. Women's participation in breast cancer screening in France--an ethical approach. BMC Med Ethics. 2014;15:64.CrossRef Moutel G, Duchange N, Darquy S, de Montgolfier S, Papin-Lefebvre F, Jullian O, Viguier J, Sancho-Garnier H. GRED French National Cancer Institute. Women's participation in breast cancer screening in France--an ethical approach. BMC Med Ethics. 2014;15:64.CrossRef
39.
go back to reference ten Have M, de Beaufort ID, Teixeira PJ, Mackenbach JP, van der Heide A. Ethics and prevention of overweight and obesity: an inventory. Obes Rev. 2011;12:669–79.PubMed ten Have M, de Beaufort ID, Teixeira PJ, Mackenbach JP, van der Heide A. Ethics and prevention of overweight and obesity: an inventory. Obes Rev. 2011;12:669–79.PubMed
40.
go back to reference Beauchamp TL. The failure of theories of personhood. Kennedy Inst Ethics J. 1999;9:309–24.CrossRef Beauchamp TL. The failure of theories of personhood. Kennedy Inst Ethics J. 1999;9:309–24.CrossRef
41.
go back to reference Nys TRV. Paternalism in public health care. Public Health Ethics. 2008;1:64–72.CrossRef Nys TRV. Paternalism in public health care. Public Health Ethics. 2008;1:64–72.CrossRef
42.
go back to reference Selgelid MJ. A moderate pluralist approach to public health policy and ethics. Public Health Ethics. 2009;2:195–205.CrossRef Selgelid MJ. A moderate pluralist approach to public health policy and ethics. Public Health Ethics. 2009;2:195–205.CrossRef
43.
go back to reference Wilson J. Towards a normative framework for public health ethics and policy. Public Health Ethics. 2009;2:184–94.CrossRef Wilson J. Towards a normative framework for public health ethics and policy. Public Health Ethics. 2009;2:184–94.CrossRef
44.
go back to reference Feinberg J. Harm to self: Oxford University Press; 1986. Feinberg J. Harm to self: Oxford University Press; 1986.
45.
go back to reference Beauchamp TL, Childress JF. Principles of biomedical ethics. Oxford: New York/Oxford; 1994. Beauchamp TL, Childress JF. Principles of biomedical ethics. Oxford: New York/Oxford; 1994.
46.
go back to reference Massé R. Éthique et santé publique, Enjeux, valeurs et normativité, 3rd edn. Presses de l’Université de Laval. 2008. Massé R. Éthique et santé publique, Enjeux, valeurs et normativité, 3rd edn. Presses de l’Université de Laval. 2008.
47.
go back to reference Bambra C. Changing the world? Reflections on the interface between social science, epidemiology and public health. J Epidemiol Community Health. 2009;63:867–8.CrossRef Bambra C. Changing the world? Reflections on the interface between social science, epidemiology and public health. J Epidemiol Community Health. 2009;63:867–8.CrossRef
Metadata
Title
Towards equity in organised cancer screening: the case of cervical cancer screening in France
Authors
Sylviane Darquy
Grégoire Moutel
Odile Jullian
Stéphanie Barré
Nathalie Duchange
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Women's Health / Issue 1/2018
Electronic ISSN: 1472-6874
DOI
https://doi.org/10.1186/s12905-018-0683-0

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