7. Inviting women to screening programmes
For informing women about the benefits and harms of participating in an organised population-based breast cancer screening programme, the ECIBC's Guidelines Development Group:
- suggests using a decision aid (conditional recommendation, low certainty of the evidence)
- recommends using numbers in addition to plain language (strong recommendation, moderate certainty of the evidence)
- suggests using infographics in addition to plain language with numbers (conditional recommendation, low certainty of the evidence)
- suggests not using storytelling in addition to plain language with number (conditional recommendation, very low certainty of the evidence)
Informing about benefits and harms: Infographics in addition to plain language
Issued on: May 2019
Healthcare question
Should infographics vs. plain language with or without numbers be used for informing women about the benefits and harms of participating in an organised population-based breast cancer screening programme?
Recommendation
The ECIBC's Guidelines Development Group (GDG) suggests using infographics in addition to plain language with numbers over plain language with numbers alone for informing women about the benefits and harms of participating in an organised population-based breast cancer screening programme.
Recommendation strength
| Conditional recommendation |
| Low certainty of the evidence |
Justification
The GDG based this decision on the balance between desirable and undesirable effects that probably favours the intervention and the fact that the intervention would probably increase equity and is probably acceptable and feasible.
Subgroup considerations
Language barriers and barriers based on numeracy and education may exist and may require specific communication strategies. The GDG developed specific recommendations on how to invite socially disadvantaged women and non-native speaking women to an organised breast cancer screening programme, these recommendations are available on our website.
Considerations for implementation and policy making
The following points should be taken into account when implementing this type of intervention:
- Considering the strong recommendation on using numbers in addition to plain language for informing women about the benefits and harms of participating in an organised breast cancer screening programme, infographics should be offered in addition to plain language with numbers.
- If information (including the numbers) is not provided appropriately, confusion may arise and certain subgroups (e.g. those with less numeracy skills) may be at a disadvantage.
- The GDG considered advantageous to pre-test the presentation format before and during implementation of the recommendation.
- Information should be provided taking into account the age of the target population of the recommendation.
- According to a Cochrane review, when communicating risk reductions, relative risk reduction, compared with absolute risk reduction, may be perceived to be larger and is more likely to be persuasive (Akl EA, 2011).
- The information should be provided using the same denominators for all the outcomes presented.
Research priorities
Specific studies on the impact of these approaches in mammography screening should be encouraged and implemented, with particular attention to the effect on certain subgroups of the population, especially those with less numeracy skills.
Supporting material
- Organised vs. non-organised screening
- Double vs. single reading in mammograpy screening
- Communication skills training
- Communication with care providers
- Optimal number of mammography readings
- Specialised training
- Risk stratification
- Women aged 40-44: screening vs. no screening
- Women aged 45-49: screening vs. no screening
- Women aged 45-49: annual vs. biennial screening
- Women aged 45-49: annual vs. triennial screening
- Women aged 45-49: triennial vs. biennial screening
- Women aged 50-69: screening vs. no screening
- Women aged 50-69: annual vs. biennial screening
- Women aged 50-69: annual vs. triennial screening
- Women aged 50-69: triennial vs. biennial screening
- Women aged 70-74: screening vs. no screening
- Women aged 70-74: annual vs. biennial screening
- Women aged 70-74: annual vs. triennial screening
- Women aged 70-74: triennial vs. biennial screening
- Single reading with AI support
- Double reading with AI support
- Screening with tomosynthesis vs. mammography
- Screening with tomosynthesis plus mammography vs. mammography alone
- Tailored screening with tomosynthesis
- Screening with tomosynthesis vs. mammography
- Tailored screening with MRI
- Tailored screening with ABUS
- Tailored screening with HHUS
- Informing about benefits and harms: use of decision aids
- Informing about benefits and harms: Numbers in addition to plain language
- Informing about benefits and harms: Infographics in addition to plain language
- Informing about benefits and harms: Story telling in addition to plain language
- Inviting women to screening: letter vs. no invitation
- Inviting socially disadvantaged women to screening: Targeted vs. general communication strategy
- Inviting women with an intellectual disability to screening
- Inviting non-native speakers to screening
- Inviting socially disadvantaged women to screening: Tailored vs. targeted communication strategy
- Inviting socially disadvantaged women to screening: Tailored vs. general communication strategy
- Inviting women to subsequent screening rounds: letter vs. no invitation
- Inviting women to screening: letter with fixed appointment vs. letter
- Inviting women to subsequent screening rounds: letter with fixed appointment vs. lett
- Inviting women to screening: letter with GP signature vs. letter
- Inviting women to subsequent screening rounds: letter with GP signature vs. letter
- Inviting women to screening: letter followed by phone call vs. letter
- Inviting women to subsequent screening rounds: letter followed by phone call vs. letter
- Inviting women to screening: letter followed by phone call vs. no invitation
- Inviting women to screening: letter followed by written reminder vs. letter
- Inviting women to subsequent screening rounds: letter followed by written reminder vs. letter
- Inviting women to screening: letter followed by face to face intervention vs. letter
- Inviting women to subsequent screening rounds: letter followed by face to face intervention vs. letter
- Inviting women to screening: e-mail vs. letter
- Inviting women to screening: automated telephone call vs. letter
- Inviting women to screening: letter followed by automated telephone call vs. letter
- Inviting women to screening: letter followed by SMS notification vs. letter
- Inviting women to screening: letter followed by personalised phone call vs. automated phone call
- Negative result: letter vs. nothing
- Further assessment: letter followed by a phone call
- Further assessment: timing of results
- Negative result: phone call vs. letter
- Negative result: face to face interview vs. letter
- Negative result: timing of results
- Tomosynthesis vs. assessment mammography
- Obtaining a sample from a suspicious breast lesion
- Type of guidance for needle core biopsy
- Stage 1: conventional exams
- Stage 1: PET-CT exams
- Stage 2: conventional exams
- Stage 2: PET-CT exams
- Stage 3: conventional exams
- Stage 3: PET-CT exams
- Stage 3: conventional exams plus PET-CT
- Use of clip-marking
- Additional magnetic resonance imaging
- Contrast-enhanced mammography
- Threshold of oestrogen for endocrine therapy
- Threshold of progesterone for endocrine therapy
- Multigene testing: 70 gene signature at low clinical risk
- Multigene testing: 70 gene signature at high clinical risk
- Multigene testing: 21 gene recurrence score
- Organising screening programmes
- Risk stratification
- Women 40-44
- Women 45-49
- Women 50-69
- Women 70-74
- Women with high breast density
- General Population
- Vulnerable Population
- Informing women about their results
- Women recalled due to suspicious lesions
- Obtaining a sample from a suspicious lesion
- Type of guidance for needle core biopsy
- Stage 1
- Stage 2
- Stage 3
- Planning surgical treatment
- Hormone receptor to guide use of endocrine therapy
- Multigene testing to guide use of chemotherapy