Ann Rudinow Saetnan

Challenges of informed choice in organised screening

Context: Despite much research on informed choice and the individuals’ autonomy in organised medical screening, little is known about the individuals’ decision-making process as expressed in their own words. Objectives: To explore the decision-making process among women invited to a mammography screening programme. Setting: Women living in the counties of Sør- and Nord-Trøndelag, Norway, invited to the first round of the Norwegian Breast Cancer Screening Program (NBCSP) in 2003. Methods: Qualitative methods based on eight semistructured focus-group interviews with a total of 69 women aged 50–69 years. Results: The decision to attend mammography screening was not based on the information in the invitation letter and leaflet provided by the NBCSP. They perceived the invitation letter with a prescheduled appointment as if a decision for mammography had already been made. This was experienced as an aid in overcoming the postponements that easily occur in daily lives. The invitation to mammography screening was embraced as an indication of a responsible welfare state, “like a mother taking care.” Conclusion: In a welfare state where governmental institutions are trusted, mass screening for disease is acknowledged by screening participants as a valued expression of paternalism. Trust, gratitude, and convenience were more important factors than information about benefits, harms, and risks when the women made their decisions to attend screening. These elements should be included in the ethical debates on informed choice in preventive medicine.

On Gender and Things: Reflections on an Exhibition on Gendered Artifacts.

In this paper, we describe an exhibition on gendered artifacts we have organized in the Netherlands and Norway. The major aim of the exhibition was to show the public the ways in which technical objects are inscribed with gender; this in order to make people aware that we live in a technological and gendered culture. Reflecting on our experiences with the exhibition, we discuss the two different approaches to theorizing the gendering of artifacts underlying the Dutch and the Norwegian version of the exhibition: the genderscript approach and the domestication approach. We conclude that the gendering of artifacts can be understood only by representing designers as well as users as active participants in the social construction of artifacts. Designers are important by shaping the initial forms, functions, and meanings of objects. Users, by their different ways of interpreting, using and talking about technologies, further contribute to their social shaping. They define whether they experience things as gendered and whether they find them useful in articulating and performing their (gender) identities. By interpreting and using technologies, users are thus active participants in shaping the gendering of artifacts.

Nothing to Hide, Nothing to Fear? Assessing Technologies for Diagnosis of Security Risks

Demand for surveillance technologies often assumes that these technologies would accurately identify those guilty of crimes and only those guilty of crimes. But how accurate are surveillance technologies as “diagnostic” tools? Surveillance technologies have not been tested for accuracy in the manner we expect for medical diagnostic technologies. Tests of medical technologies are designed to address sensitivity (How many of those affected by a disease does the test identify?) and specificity (How many unaffected by the disease does the test show as healthy?). Even for tests with more than 90% sensitivity and specificity, the majority of test positive results are false. Using value estimates for facial recognition and DNA identification, this article estimates the answers to these questions for crime surveillance technologies. The vast majority of test positive results would be false. In other words, even those of us with “nothing to hide” may have much to fear from crime surveillance technologies.Demand for surveillance technologies often assumes that these technologies would accurately identify those guilty of crimes and only those guilty of crimes. But how accurate are surveillance technologies as “diagnostic” tools? Surveillance technologies have not been tested for accuracy in the manner we expect for medical diagnostic technologies. Tests of medical technologies are designed to address sensitivity (How many of those affected by a disease does the test identify?) and specificity (How many unaffected by the disease does the test show as healthy?). Even for tests with more than 90% sensitivity and specificity, the majority of test positive results are false. Using value estimates for facial recognition and DNA identification, this article estimates the answers to these questions for crime surveillance technologies. The vast majority of test positive results would be false. In other words, even those of us with “nothing to hide” may have much to fear from crime surveillance technologies.

Experiences of Recall After Mammography Screening—A Qualitative Study

Women participating in biannual mammography screening for 20 years have a cumulative risk of 20% of being recalled. We conducted a prospective qualitative interview study with eight nonsymptomatic women recalled after mammography screening. These women expressed mixed emotions over being recalled. Information about recall rates and breast cancer risk was seen as alarming, and cancer risk estimates were seen by some as high. The short time between recall and examination was reassuring, but it was also perceived as an indication of malignancy. Despite distress from examinations, most of the women continued to want medical examinations to detect cancer early.

Look to norway

The authors of the paper argue that Norways national health service, despite public perceptions, is both inexpensive and technologically advanced. Norway has a highly regulated medical system at both the national and local levels, and many distribution issues take the form of political debate. As a result, the authors believe that medical care and equipment is equitably distributed, but perhaps over-densely, throughout the country. Although the overall picture is optimistic, there is some concern that technologies, health care priorities, and decision-making processes should be more carefully examined by consensus conferences, advisory groups, and experts in technology assessment.

Mammography screening and trust: The case of interval breast cancer

Interval cancer is cancer detected between screening rounds among screening participants. In the Norwegian Breast Cancer Screening Programme, 19 per 10,000 screened women are diagnosed with interval cancer. We conducted semi-structured interviews with 26 such women. The women interpreted their interval breast cancer in two ways: that mammography can never be completely certain, or as an experience characterized by shock and doubts about the technology and the conduct of the medical experts. Being diagnosed with interval cancer thus influenced their trust in mammography, but not necessarily to the point of creating distrust. The women saw themselves as exceptions in an otherwise beneficial screening programme. Convinced that statistics had shown benefits from mammography screening and knowing others whose malignant tumours had been detected in the programme, the women bracketed their own experiences and continued trusting mammography screening. Facing a potentially lethal disease and a lack of alternatives to mammography screening left the women with few options but to trust the programme in order to maintain hope. In other words, trust may not only be a basis for hope, but also a consequence of it.

Reduced Use of Diagnostic Obstetric Ultrasound in Norway: Result of Consensus Panel Recommending Routine Screening in Pregnancy?

Purpose: To investigate the practice of obstetric ultrasound in Norway before and 2 years after a consensus conference recommending routine screening.

Could screening participation bias symptom interpretation? An interview study on women's interpretations of and responses to cancer symptoms between mammography screening rounds

Objectives To explore how women with negative mammography screening results, but who were later diagnosed with interval breast cancer, reacted when they observed breast symptoms that could indicate malignancy in-between screening rounds. Design Semistructured individual interviews with women who have been diagnosed with breast cancer during mammography screening intervals. Setting Two breast diagnostic units covering two counties in Norway. Participants 26 women diagnosed with interval breast cancer. Results Women with a screening negative result react in two ways when experiencing a possible symptom of breast cancer. Among 24 women with a self-detected palpable lesion, 14 sought medical advice immediately. Their argument was to dispose of potential cancer as soon as possible. Ten women delayed seeking medical advice, explaining their delay as a result of practical difficulties such as holidays, uncertainty about the symptom, and previous experiences of healthcare services’ ability to handle diffuse symptoms. Also, a recent negative mammography scan led some women to assume that the palpable lesion was benign and wait for the next screening round. Conclusions Participating in mammography screening may contribute to a postponed reaction to breast cancer symptoms, although most women acted rapidly when detecting a palpable breast lesion. Furthermore, screening participation does not necessarily increase awareness of breast cancer symptoms.

Focus Groups in a Medicine-Dominated Field: Compromises or Quality Improvements?

Mammography screening has traditionally been viewed as a field for medical research. The medical science discourse, however, is highly quantitative, and its claims for validity somewhat opposed to those of qualitative research. To communicate research in a cross-disciplinary field, it is necessary to adapt ones research to several paradigms. The authors conducted focus group interviews with women due to be screened in a national breast cancer screening program. Their prospective design, both strategic and random sampling, and free discussions during focus groups are all questions of satisfying a medical science discourse in the frames of qualitative research. Focus group research showed itself adaptable through the data collection phase in a cross-disciplinary research project on mammography screening.

Scientific? democratic? effective? Towards an evaluation of Norway's first medical consensus conference

From 1986 to 1992, Norway organized a series of medical consensus conferences as a test of how that format would function in a Norwegian health policy context: the first was on the use of ultrasound in pregnancy. In 1995, Norway organized its first consensus conference since the test series. Again the subject was ultrasound in pregnancy. This paper evaluates several aspects of the first conference, in light of the need for a second on the same technological practices so soon after. It focuses on how the first consensus statement has been understood by its targeted professional populations and how the first conference balanced the potentially conflicting goals of achieving science-based and/or broad-based medical technology policies. The analysis combines previously published evaluation results with new observational, archival, interview, and survey data. Copyright , Beech Tree Publishing.