Breast screening policy in Britain is based on women's age, as it should be. Age is the most important risk factor for breast cancer, and in younger women the health gain from screening is vanishingly small. A lower age limit is therefore rational. But when age related decisions are irrational or inequitable, they may reflect ageism. Is this the case with the upper limit for breast screening?

The NHS screening service follows the recommendation in the Forrest report that in view of poor response rates there is insufficient benefit from offering screening to women aged 65 and over, though it may be available on request.1 This recommendation was based on the Utrecht study and the United Kingdom trial,2 3 both of which apparently showed a rapid fall in acceptance of repeated screening over 65.1 In Sweden, by contrast, uptake was 80% to age 74.4 However, neither the Utrecht nor the British trial recruited women over 65. Forrest presumably meant the Nijmegen study, where women …