What Information on Mammographic Screening is Available to Women in Quebec, Ontario and Canada: Results from a Document Analysis.

Information provided to women invited to participate in mammography screening is crucial in supporting informed consent. Expert recommendations remain divided, and the ethical framing of autonomy, especially in shared decision-making, often fails to reflect the realities of clinical practice. This study examines how public-facing documents communicate screening information and explores whether relational autonomy offers a more ethically coherent approach. A document analysis was conducted using the READ method. Documents published between 1999 and 2023, from Quebec, Ontario or Canada, containing the keywords 'breast cancer screening' and 'screening mammography' were included and assessed using a 16-category grid. Fifty-one documents were included (Qc: 16, On: 10, Can: 25) and 11 were excluded. 10 per cent included women from the public, but the majority of contributing experts were women (57 per cent). 96 per cent of documents were considered inaccessible based on the Flesch-Kincaid Grade Level score. Benefits were mentioned more often than risks (90 per cent vs 37 per cent) and 16 per cent confused diagnosis and screening. Women under 50 were overrepresented (37 per cent) and racialized women underrepresented (58 per cent). This analysis reveals biases in how screening information is designed and communicated. Relational autonomy offers a more inclusive framework for evaluating and improving screening communication.