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Breast cancer screening discussions for women in their forties.

Studies of the effectiveness of breast cancer screening for women in their forties show that the probability of benefit is relatively small and, for some women, may be outweighed by the probability of harm. Thus, screening for breast cancer in this age group is a "close call" on which reasonable women may disagree. Many women in their forties, however, are being screened. We suggest that few truly understand the issues involved in this decision. In this paper, we examine the potential benefits and harms of breast cancer screening for women ages 40-49 and consider a strategy for helping women make informed decisions about screening: shared decision making. Shared decision making involves framing breast cancer screening as a decision that could reasonably be decided either for or against screening; giving the patient evidence-based information about the decision in an understandable format; and assisting the patient to use her values to close on a decision. We believe that this approach will eventually become the standard of care not only for breast cancer screening for women in their forties, but for older women (and other issues), as well.