Back in 1989 Maureen Roberts, clinical director of the Edinburgh breast screening project, wrote poignantly in an article entitled “Breast screening: time for a rethink”: “I am in a reflective mood as I lie here in the sunshine at the end of my life. Breast cancer has caught up with me after eight good years” (BMJ 1989;299: 1153-5).

Fast forward to autumn 2004. A 69 year old woman—age 13 at menarche, age 22 at first birth, no family history of breast cancer, on oestrogen only hormone replacement therapy for 15 years—was referred to a surgeon because of discomfort in her left breast. As requested, she brought her most recent mammograms. On clinical examination neither patient nor surgeon could see or feel any abnormality in either breast. Bilateral diagnostic mammography showed a normal left breast but an obvious breast cancer in the right breast at 6 o'clock. Although it was smaller, the cancer was also clearly evident on previous mammograms.

Enthusiasm …