BMJ  2006;332:728 (25 March), doi:10.1136/bmj.332.7543.728-a

Letter

Ramifications of screening for breast cancer

More debate and better information still needed

EDITOR—Rather than end the debate about screening, as Dixon's editorial suggests,¹ and look to the future, it would be preferable to raise the current level of debate by presenting balanced arguments, avoid misleading presentation of statistics, and consider current evidence about over-treatment² and poor quality information.³ Efforts may have been made, as Dixon says, to provide women with sufficient information to make an informed choice, but they have not been successful: the quality still falls far short. The criticism made in 2003 is still valid.⁴

Barratt et al have since devised a model of outcomes of mammographic screening showing estimates of benefits and harms that is readily usable by women considering breast screening.⁵ They advise that comprehensive information about cancer screening, in line with recommendations from the General Medical Council, should be balanced (describing benefits and harms over a similar time frame, such as 10 years) and that estimates should be presented with a constant denominator (such as per 100 or per 1000 people). This model and advice, and other decision aids and tools are available, but none has been provided by the NHS breast screening programme to women, as recommended in 2003.⁴

If breast screening is to move on, then it is time the proponents of breast screening moved on, not just to the future, but to the present. Women today do not want to be patronised, or fobbed off with unbalanced, insufficient information, but to be treated with respect, so that they can make up their own minds. Decision making, to give proper consent, requires good quality information. It is evident that they are not getting it.³

Department of Health Sciences, University of Leicester "Saionara," Rowhedge, Colchester CO5 7EA hazelcagct{at}keme.co.uk

---

See Research p 689

Competing interests: None declared.

References

1. Dixon JM. Screening for breast cancer. BMJ 2006;332: 499-500. (4 March.)[Free Full Text]
2. Zackrisson S, Andersson I, Janzon L, Manjer J, Garne JP. Rate of over-diagnosis of breast cancer 15 years after end of Malmö mammographic screening trial: follow-up study. BMJ 2006;332: 689-92. (25 March.) doi: 10.1136/bmj.38764.572569.7C (published 3 March 2006).[Abstract/Free Full Text]
3. Jorgensen KJ, Goetzsche PC. Content of invitations for publicly funded screening mammography. BMJ 2006;332: 538-41. (4 March.)[Free Full Text]
4. Thornton H, Edwards A, Baum M. Women need better information about routine mammography. BMJ 2003;327: 101-3.[Free Full Text]
5. Barratt A, Howard K, Irwig L, Salkeld G, Houssami N. Model of outcomes of screening mammography: information to support informed choices. BMJ 2005;330: 936-8.[Abstract/Free Full Text]

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