In Germany, the invitation to undergo mammography screening that is sent to all women between the ages of 50 and 69 is accompanied by an information leaflet explaining the advantages and disadvantages of screening. In this issue of Deutsches Ärzteblatt International (Dtsch Arztbl Int 2015; 112: 61-8), Elisabeth Gummersbach and colleagues report on a study in which they determined how well the prospective subjects understood the information presented and whether this information influenced their willingness to undergo screening. It was found that the leaflet itself made little or no difference to the women's willingness to participate. Rather, the most important factor in the decision whether to be screened was usually a doctor's personal recommendation.
From 2010 onward, mammography for the early detection of breast cancer has been recommended for all women in Germany aged 50 to 69. Screening nonetheless remains controversial. While it is true that women who undergo screening are less likely to die of breast cancer, they may also receive erroneous diagnoses and unnecessary treatments. Out of 1000 women who undergo mammography screening regularly for 10 years, 1 to 3 will survive who would otherwise have died of breast cancer, but 100 to 300 will have a false positive mammography finding that can cause considerable emotional distress. As many as 5 of these women may actually undergo unnecessary treatment for cancer. As the authors point out, the leaflets apparently had little or no effect on the women's decisions to undergo screening or not: only 3.6% said it played a role in their decision, while nearly 50% said their doctor's recommendation was a major factor. These findings imply that a leaflet alone does not enable women to make a well-informed decision about mammography screening, as required by current German law. The authors recommend that women who are candidates for mammography should have a personal discussion with an appropriate professional about this subject, in addition to being given suitable written information.