Is maximizing the promotion of breast cancer screening ethically and morally justifiable?

Breast cancer remains a pressing global health challenge, yet the ethics of promoting widespread screening are far from settled. This paper examines breast cancer screening through the principles of biomedical ethics – respect for autonomy, beneficence, nonmaleficence, and justice – while situating these principles within broader sociocultural realities. Mammography (MAM) and ultrasound (US) have demonstrated effectiveness in early detection, but they also generate unintended harms. Overdiagnosis, unnecessary interventions, and the psychological weight of false-positive results complicate the assumed alignment between beneficence and nonmaleficence. International guidelines reveal divergent ethical priorities. Some regions advocate for earlier screening to maximize potential survival gains, while others delay initiation to minimize harm from overtreatment. China faces a distinctive case, where younger onset and higher breast density shift the balance toward ultrasound as a primary tool. These contextual differences highlight that screening policy is not merely about epidemiology, but also about ethical reasoning shaped by cultural norms and health system constraints. This paper argues that maximizing promotion – public health campaigns and “nudges” designed to boost participation – risks reducing women to passive targets of intervention. Such strategies may undermine informed consent, especially where health literacy is limited, and exacerbate disparities in access. Justice thus requires more than resource allocation; it requires enabling equitable “health capabilities.” We conclude that a uniform, “one-size-fits-all” screening model is ethically insufficient. Risk-stratified, individualized screening protocols are not only scientifically sound but also morally necessary, as they better respect autonomy, minimize systemic harm, and address inequities in public health practice.