Who chooses when an operation is worth having?

EDITOR—In view of the many excellent publications recently in the BMJ on the need to involve consumers in decisions about treatment and screening,1 I am concerned that Urban's editorial on ovarian cancer includes the statement: “Five operations for each cancer found is an acceptable surgery to malignancy ratio.”2

To whom is five operations to find one cancer an acceptable ratio? Women? Health authorities? Surgeons? Radiologists? Surely it is time to abandon this paternalistic and rigid approach of prescribing what is or is not an acceptable trade-off of benefits and risks and then implementing that for everyone. Consumers should be given the opportunity to decide whether, for them, the benefit is worth the risk. For those of us in the health business, our role should be to support consumers in their decision making rather than to make judgments for everyone.

Mass screening may not prove to be sound public health policy

EDITOR—Urban persuasively makes the scientific case for a definitive trial of ovarian screening, but it is important to consider the wider public health context.1 A public health policy of mass screening for ovarian cancer may not prove feasible for …