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Breast cancer screening

Ethical nudging?

Published online by Cambridge University Press:  02 May 2018

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Abstract

Cass R. Sunstein’s 2016 book The Ethics of Influence: Government in the Age of Behavioral Science provides an extremely informative introduction to the science and ethics of the exercise of “influence” over others. As a longtime physician employed in both the public and private sectors, I now recognize that most of my formal training has been in the hard sciences, with little, if any, training in the appropriate influence of the decision-making processes of my patients and/or other health care professionals in institutional settings. Breast cancer screening is an excellent example of the conflicts of modern medicine, highlighting our collective inability to effectively “nudge” others in the pursuit of health and/or organizational effectiveness and efficiency. Using the framework of Sunstein’s ethical values of welfare, autonomy, dignity, and self-government, I discuss many of the conflicting issues in a nationwide breast cancer screening program and the effects of these issues on client nudging to determine whether mammography screening is ethical.

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Forum
Copyright
© Association for Politics and the Life Sciences 2018 

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References

Sunstein, C. R., The Ethics of Influence: Government in the Age of Behavioral Science (New York: Cambridge University Press, 2016).Google Scholar
U.S. Preventive Services Task Force, “Breast cancer: Screening,” November 2009, https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening (accessed February 27, 2018).Google Scholar
American Cancer Society, “Guidelines for the early detection of cancer,” 2017, https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html (accessed February 27, 2018).Google Scholar
American College of Radiology, “ACR and SBI continue to recommend regular mammography starting at age 40,” October 20, 2015, https://www.acr.org/About-Us/Media-Center/Press-Releases/2015-Press-Releases/20151020-ACR-SBI-Recommend-Mammography-at-Age-40 (accessed February 27, 2018).Google Scholar
U.S. Preventive Services Task Force.Google Scholar
American Cancer Society.Google Scholar
American College of Obstetricians and Gynecologists, “ACOG statement on revised American Cancer Society recommendations on breast cancer screening,” October 20, 2015, https://www.acog.org/About-ACOG/News-Room/Statements/2015/ACOG-Statement-on-Recommendations-on-Breast-Cancer-Screening (accessed February 27, 2018).Google Scholar
American Society of Breast Surgeons, “Consensus statement on screening mammography,” October 29, 2015, https://www.breastsurgeons.org/new_layout/about/statements/PDF_Statements/Screening_Mammography.pdf (accessed February 27, 2018).Google Scholar
U.S. Food and Drug Administration, “Mammography Quality Standards Act and Program, https://www.fda.gov/radiation-emittingproducts/mammographyqualitystandardsactandprogram/ (accessed February 27, 2018).Google Scholar
Cancer Research UK, “Breast screening,” October 18, 2017, http://www.cancerresearchuk.org/about-cancer/breast-cancer/screening/breast-screening (accessed February 27, 2018).Google Scholar
PubMed Health, “The breast cancer screening program in Germany,” January 27, 2016, https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0087094/ (accessed February 27, 2018).Google Scholar
PubMed Health.Google Scholar
Biller-Andorno, N. and Jüni, P., “Abolishing mammography screening programs? A view from the Swiss medical board,” New England Journal of Medicine , 2014, 370: 19651967.Google Scholar
Biller-Andorno and Jüni.Google Scholar
National Cancer Institute, “Breast cancer risk in American women,” September 24, 2012, https://www.cancer.gov/types/breast/risk-fact-sheet (accessed February 27, 2018).Google Scholar
O’Donoghue, C., Eklund, M., Ozanne, E. M., and Esserman, L. J., “Aggregate cost of mammography screening in the United States: Comparison of current practice and advocated guidelines,” Annals of Internal Medicine , 2014, 160(3): 145153.Google Scholar
American Cancer Society.Google Scholar
“Mammography follow-up rates,” Florida Medicare Quality Improvement Organization, 2009, http://www.qualityreportingcenter.com/media/OP-9%20Mammography%20Follow-up%20Rates_LitRev.pdf.Google Scholar
John Stuart Mill, quoted in Sunstein, p. 56.Google Scholar
American Cancer Society.Google Scholar
American College of Radiology.Google Scholar
U.S. Food and Drug Administration.Google Scholar