May 5, 2016 — Only one in three women participating in Germany's mammography screening program (MSP) is well-informed about it: the higher the level of education, the greater the chance of women making an informed decision. These are the results of a study that healthcare researchers at Bielefeld University published in the international specialist journal PLOS ONE.
“Further information and support services are needed to spread more knowledge about the program — especially to women with little education and women with a Turkish migration background,” said junior professor Jacob Spallek, who ran the study together with Prof. Petra Kolip.
The MSP is open for all women in Germany over the age of 50. It can help detect and therefore treat breast cancer at an early stage. However, because not every screening delivers a clear outcome, mistakes can sometimes lead to false diagnoses, overtreatment, or stress. Spallek said, “That is why every woman should take care to find out about the risks and the benefits before accepting the invitation to attend mammography screening.” The researchers have studied how much women know about the screening and how they then decide in favor of or against it.
Breast cancer is the most frequent type of cancer among women. Early diagnosis through MSP can help to lower the mortality rate. Every two years, women aged between 50 and 69 years are invited to attend MSP. Nonetheless, there is controversy over whether the potential disadvantages of screening possibly outweigh the advantages. This is why the concept of 'informed choice' has become increasingly more important in the health sciences. It states that whoever has sufficient knowledge about a proposal can form her own opinion about it and make a conscious choice.
The goal of the research project was to describe which proportion of women in general and which proportion of women with a Turkish migration background decide in favor of or against MSP — and also make an informed choice.
“For the result, it didn't matter whether the choice was for or against the screening,” Spallek explained. “The only thing that was important was whether the decision was based on sufficient information.”
Participants were approximately 5,000 women in the Westphalia-Lippe region who were invited to attend an MSP for the first time. A total of 27.1 percent of the invited women made an informed choice for or against participating in the MSP. Whereas 28.2 percent of the women with no migration background made an informed choice, this was 21.8 percent among ethnic German immigrants [Spätaussiedlerinnen] and 20 percent among women with other countries of origin. The lowest proportion of informed decisions came from women with a Turkish migration background, at 5 percent.
“In sum, there is room for improvement in the proportion of informed choices when it comes to MSP in Germany,” concluded Spallek.
For more information: www.journals.plos.org/plosone
March 13, 2026 
