Introducing patient values into the decision making process for breast cancer screening

Breast cancer is a serious and feared disease, and its management is a significant public health issue. Mammographic screening is a control strategy for this disease but its application in the United States is controversial. This article provides a brief review of the literature on physician/patient interaction styles, then proposes a comprehensive model that integrates the values and factors relevant to the decision over the spectrum of possible interaction styles. The issue of how screening program decisions for an individual woman should be made is considered in light of the current U.S. practice of offering population-wide screening guidelines. This approach is examined and contrasted with an approach in which individual patient values and preferences are used. The article offers some insights into how these values might be obtained so that they may be included in the decision-making process.