Financial incentives for breast cancer screening undermine informed choice
Theodore Bartholomew, Mirela Colleoni, and Harald Schmidt argue that the focus should be on decision making not uptake when the balance of benefit and harm is subjective Breast cancer is the most common cause of cancer death for women worldwide.1 Various measures have been explored to reduce breast cancer mortality. One approach is to encourage screening through financial incentives for patients or providers, as recently proposed in France and the UK, respectively.234 Several countries already use some form of incentive, and the extent to which they are being offered, in combination with ambitious screening targets, could suggest that their use is an appropriate way to promote population health. This, however, is far from clear: there are major concerns about breast cancer screening, the effectiveness of financial incentives is unclear, and there is an urgent need to ensure that women have given their valid consent—that is, informed and without undue influence—for screening. Some trans