The growing number of people diagnosed with cancer, together with the limitations of cancer prevention and current screening methods, is driving the development of new screening technologies. The goal is to improve cancer prediction and enable earlier detection than is currently possible, thereby enhancing prognosis and chances of cure, while also reducing false-positive screening results and overdiagnosis. Following this line of reasoning, cancer screening in Sweden is entering a phase of extensive transformation. The National Board of Health and Welfare's analysis of the future of cancer screening in Sweden implies the introduction of new cancer screening programmes, as well as changes in current cancer screening¹. Technology development, for example, the introduction of artificial intelligence in breast cancer screening, shows promising results of improved performance of screening. Artificial intelligence might also sufficiently replace a second mammogram reader (a radiologist) and, moreover, be used for triage in screening to prioritise women for further diagnostic work-up. These solutions provide a more efficient allocation of personnel resources in screening, consequently supporting equal accessibility to breast cancer screening programmes in populations. Pseudo-3D mammography (tomosynthesis) is proven to increase breast cancer detection and is contributing to changes in screening practices, particularly for women whose 2D mammography demonstrates low sensitivity, such as those with dense glandular breast tissue. 

Early, curable stage of prostate cancer can be detected by a simple blood test, prostate-specific antigen, followed by diagnostic imaging work-up, but needs to be organised in the population for equal information provision, and the same prerequisites for attendance as opposed to opportunistic screening. Algorithms to reduce the high rate of overdiagnosis in prostate cancer screening are currently being evaluated. Furthermore, development is also recommended for cancer screening of high-risk groups. For example, low radiation dose computed tomography of the lungs was shown as an effective method to diagnose lung cancer in a symptom-free phase of the disease in risk groups such as smokers and previous smokers. Also, a performance evaluation of the surveillance programme with magnetic resonance tomography of the breasts in a hereditary high-risk of breast cancer was suggested to be frequently updated for up-to-date improvements. 

A new area in cancer management is active surveillance; monitoring low-risk cancer as an alternative to invasive treatment, which might reduce overtreatment that otherwise is a significant consequence of cancer screening. Individualised screening, based on the person's risk profile of developing cancer, might also be introduced in a not-so-distant future. Overall, cancer screening is entering a new phase—“cancer screening 2.0.”

The challenge. The transition increases complexity of screening and raises multiple ethical considerations, not least among people who are invited to screening. Innovations in screening might question people's trust in the screening programmes, potentially affecting their decision on attendance, therefore adequate information to the public is crucial. Furthermore, cancer screening refers to a large part of the adult population, but some groups are still underrepresented. 

Cancer screening aims to reduce cancer mortality among people and refers to the population; however, the information about effects of screening as well as potential benefits and harms for the individual needs to be communicated at the individual level, which gives rise to an informational paradox. In addition, the invitation to cancer screening and information leaflets are often neither developed among lay people nor do they account for an individual perspective. The aspects of cultural beliefs and values in the context of healthcare are seldom included, and only a language translation of the information is usually performed. Merely a translation of target information, although valid, comprehensive and comprehensible, has been revealed to provide no effect on screening attendance in underrepresented groups². The same information to everyone should not be mistaken for equal opportunities for decision-making and attendance in screening. Keeping this line of reasoning, people are not sufficiently informed about screening, despite their attendance being framed as autonomous choice, thus revealing another paradox inherent in screening. 

Clinical experience, guidelines, and research show that invitations to cancer screening focus on providing objective information about the benefits and risks of screening, aiming to create cognitive understanding of screening among people. However, health literacy and informed decision-making is multifaceted; it is influenced by a person’s experiences, emotional traits and state, values, and beliefs, as well as their socio-economic background, culture, and context. Decision-making is dynamic and contextual. Cancer screening information materials should be developed through attentive listening and tailored in response to individuals’ circumstances—addressing their specific questions, values, abilities, and needs—represent a new paradigm in cancer screening, a person-centred approach to the people in healthcare. 

Research on people's perspectives on cancer screening has the potential to improve person-healthcare personnel communication, and to introduce person-centred care in screening. In Sweden, there is a paradigm shift towards person-centredness in care that means the person has an active part in decision-making for the benefit of co-created own care³.

The philosophy of person-centred care emphasises building relationships and places the person-personnel relationship at the core of care⁴. The core values of this concept include respect for the autonomy, and norms, beliefs, and preferences of the person. Person-centred care is an ethical approach that involves seeing and treating the patient as a person, not merely as a carrier of a disease or someone in need of care. It aims to prevent the traditional balance of power in healthcare between healthcare provider and patient. Being a patient entails a distinct role within the healthcare system, characterised by the individual’s symptoms as well as their physical, mental, and functional health. In this context, the patient is primarily viewed as a recipient of healthcare services. However, this role is inherently limited; patients often find themselves in unfamiliar environments, detached from their social support systems, which otherwise provide them with a sense of security. Moreover, patients face an existential disadvantage due to their illnesses, rendering them vulnerable and fragile. This vulnerability is compounded by a cognitive disadvantage that arises from the complexities of the healthcare environment, where specialised medical knowledge is paramount. Consequently, patients are compelled to navigate a system that requires them to seek out professional expertise, placing them in a position of dependency^5-6.

In our context of diagnostic imaging, the power imbalance means that radiographers possess expertise regarding radiographic examinations while the patient is in a foreign environment. By offering shared expertise—asking questions, listening, and performing the examination in accordance with the patient’s experiences, values, and their condition—we can create the circumstances for patient participation, which is another cornerstone of person-centredness. When we listen to the patient’s preferences and act based on them, we do not just see the patient; we see the person. It is in this encounter that true person-centred care arises. In shared expertise, we integrate our evidence-based knowledge and practice⁷.

Two studies were recently published in the context of surveillance with annual magnetic resonance tomography of the breasts for early detection of breast cancer, which may be offered to women with a hereditary risk for the disease^8-9. The studies were conducted by one of my doctoral students, Ann-Sofi Sjöqvist, a registered radiographer, and they were performed in a research collaboration in the department of Diagnostic Imaging, Malmö, Lund University, Sweden. Fourteen women participating in a surveillance programme within the Skåne Regional Council in Sweden were interviewed individually on two occasions. Two study designs were used, phenomenography and hermeneutic phenomenology, to explore women’s perceptions of surveillance and the meaning of their experiences of surveillance, respectively. The study findings support the development of person-centred care practices in radiography and across women’s cancer diagnostics and care, particularly in the context of hereditary breast cancer risk and high-risk screening programmes.

The findings revealed that women perceived themselves as less important than other patients, while also feeling that they occupied valuable time that could be given to others. Despite these perceptions, they expressed gratitude for being offered surveillance, even though they viewed themselves as an economic burden to society. These insights highlight the responsibility of radiographers and other healthcare professionals to advocate patients, promote and protect their rights, ensure equitable access to care, and support inhabitants and patients in understanding their entitlements in healthcare.

Women with a high hereditary risk of breast cancer have an alternative to surveillance for early detection of the tumour: risk-reducing mastectomy, the surgical removal of both breasts, which almost eliminates the risk of developing breast cancer. Our findings showed that women were aware of their decision to postpone mastectomy and instead participate in the surveillance programme. They consciously selected this path as they value their breasts as integral to their identity, body, and sense of self. These findings challenge healthcare norms that construct breasts as merely a body part when viewed through the lens of treatment and survival. When considered within the framework of person-centred care, this highlights our responsibility to respect patients’ informed and autonomous decisions. By listening to their life stories, experiences, and expectations—and integrating these with evidence-based practice, professional knowledge, and ethical principles—we can share expertise and build partnerships in care.

Person-centred care involves reflecting on one’s professional practice, and continuously probing and developing one’s values, beliefs, and attitudes—both toward patients and in relationships with colleagues. It also offers an opportunity to collaboratively strengthen person-centred practice within teams: fostering inclusivity, learning with and from one another, offering recognition, and having the courage to provide constructive feedback. Reflection, understood as an ethical stance, serves as a safeguard for our professional integrity.

Advancing self-awareness in the profession requires strong leadership—providing clear direction, guidance, and support to build a culture of learning. Learning from one another within the organisation can strengthen person-centred care by fostering positive emotions, engagement, collaboration, and relationships. However, proactively supporting and constructively challenging colleagues is not yet common practice. Leaders therefore play a key role by engaging openly with staff, staying present, and clearly prioritising the development of a learning culture—an essential aspect of person-centred care leadership¹⁰. 

The interplay between person-centred care and technological and diagnostic advancements appears to create a contradiction. While person-centredness in healthcare introduces challenges within increasingly digital environments, it also presents opportunities for shared decision-making. The integration of person-centred care within high-tech radiography settings raises several important questions:

1. How can radiographers, along with clinical practice, policies, and governance, embrace the digital environment and technological advancements while integrating person-centred care?
2. Which person-centred care practices can be implemented to address the challenge of aligning its philosophy with radiography practice?
3. What ethical challenges arise in the development and implementation of technology in relation to person-centred care?
4. In what ways might person-centredness influence the workforce and interprofessional collaboration?

Through research and in conversations with colleagues in the field of diagnostic imaging, a diverse group including clinical practitioners, students, educators, researchers, and managers, I have started to explore the concept of person-centredness in radiography. Person-centred care involves not only our understanding of the ethical philosophy and theoretical framework, but it is a path towards an identity within our profession of radiography.

• Patient Encounters: Radiographers play a vital role in patient interactions during examinations. Our responsibility extends beyond technical skills; it includes listening to and respecting the patient’s narratives, experience, abilities, expectations and emotional needs during the examination. We are guardians of patient autonomy in shared decision-making in radiography^6-9. 
• Fostering Relationships: Building relationships within the radiographic team and with colleagues in diagnostic imaging is essential. Person-centred communication and collaboration in the team is a cornerstone for person-centredness in care¹⁰.
• Team dynamics: By recognising the importance of teamwork, we can better integrate person-centred care into our practice. Each member of the team contributes unique insights that can improve patient outcomes and their pathway in healthcare¹⁰. 
• Scientific Foundations: We are now starting to define, on a scientific basis, what it means to be the link between patient and technology. Establishing a shared understanding of what person-centred care means in our field is a key¹¹. 
• Developing Person-Centred Practice: A commitment to creating, validating and implementing sufficient methods that support person-centred radiography practice is essential. This includes guidelines, tools, and training that merge the patient perspective with the requirements of the radiographic examination^6-9.

Our journey towards person-centred healthcare in radiography has just started, but our collective enthusiasm and reflective practices position us well to make meaningful contributions. By aligning research, education, and practice around a shared vision, we can enhance the care we perform in radiography and strengthen the patient-radiographer relationship in high-tech diagnostic environments.