{
  "abstract": "Fear and guilt are powerful drivers for motivating populations to adhere to public health measures. Messages and images of diseased organs on cigarette packets are widely used in campaigns to discourage smoking, which is notoriously linked to the development of bronchopulmonary cancer.An ethical problem with using fear and guilt as persuasive levers arises when they are used in campaigns for public health measures whose risks and drawbacks are well known today but insufficiently communicated to the public. This is the case for mammography screening.Wording or images with a strong anguishing and/or guilt-inducing impact have been recurring in all Pink October campaigns since their launch. Words with strong connotations and emotional impact are employed to describe breast cancer or to emphasize the ‘urgency’ of screening.Studies have shown that exaggerated wording and typographical presentation contribute to the overestimation of women’s risk of developing breast cancer.The fact that X number of women have already undergone screening is put forward to stigmatize those who still haven’t, make the latter feel guilty, and suggest they join the group of participants. This is the ad-populum argument.Several studies have pointed out that health authorities use these methods to increase cancer screening. One of them recently revealed the methods of influence used on women, including fear, and pointed the finger at the shortcomings of the French Cancer Institute, which misused statistical data and risk presentation.Another study uses women’s manipulation as a scientific approach. It shows that the participation rate of women receiving biased information more focused on the supposed adverse consequences of not having a mammogram is significantly higher than in the better-informed group.The Cancer Rose collective has evaluated its decision-support tool.Is it relevant? Useful? Does it provide the necessary information? Does it affect participation in screening?And does it counterbalance the guilt-inducing messages of October Rose?Several actions have been conducted.The tool was evaluated as part of a study for a general medicine thesis. Cancer Rose decision tool and a questionnaire were distributed to volunteer women, and answers were extracted and analyzed.In parallel, a short questionnaire for a specific survey on the ‘guilt’ aspect was distributed to other volunteer women by a fellow primary care physician who organizes dedicated consultations on information on screening in general.Furthermore, Cancer Rose collected testimonials posted by women on the ‘contact’ page of the cancer-rose.fr website.Our findings suggest that a decision-support tool considerably reduces women’s anxiety and guilt levels, helping them to make a more serene decision about whether or not to participate in mammography screening.Objectives Evaluation how fear and guilt are powerful drivers for motivating populations to adhere to public health measuresMethod Assessment of the Cancer-Rose decision-aid support with a comprehensive questionnaire.In parallel an second evaluation was carried out by a short questionnaire for a specific survey on the ‘guilt’ aspect to other volunteer women by a fellow primary care physician who organizes dedicated consultations on information on screening in general.Furthermore, Cancer Rose collected testimonials posted by women on the ‘contact’ page of the cancer-rose.fr website.Results Wording or images with a strong anguishing and/or guilt-inducing impact have been recurring in all Pink October campaigns. Exaggerated wording and typographical presentation contribute to the overestimation of women’s risk of developing breast cancer. French health authorities use these methods to increase cancer screening because participation rate of women receiving biased information more focused on the supposed adverse consequences of not having a mammogram is significantly higher than in the better-informed women..Conclusions Our findings suggest that a decision-support tool considerably reduces women’s anxiety and guilt levels, helping them to make a more serene decision about whether or not to participate in mammography screening.",
  "authors": [
    {
      "affiliations": [
        "Cancer Rose association, Jouy Aux Arches, France"
      ],
      "name": "Cécile Bour"
    },
    {
      "affiliations": [
        "Cancer Rose association, Albi, France"
      ],
      "name": "Jean Doubovetzky"
    }
  ],
  "title": "024 Fear and guilt to promote women’s participation in breast cancer screening",
  "uid": "ed11a45d-c662-5d3a-8bac-c9884d90b5ba"
}