Invitations to screening mammography play a central part in the process of obtaining informed consent. It is the only source of information distributed to all potential participants. Other sources, such as pamphlets and websites, have been shown to be information poor and biased in favour of participation,1 2 ^{w1 w2} and information from the media and doctors is likely to vary and be unevenly distributed. We examined mammography invitations from English speaking and Scandinavian countries with publicly funded screening to assess whether they provide sufficient information to enable women to make an informed decision.

Information versus high uptake

When a society decides to offer cancer screening, eligible citizens need to be made aware of the programme. A letter of invitation is a common approach, and it seems obvious to use this letter to provide balanced information about benefits and harms of screening, particularly since there is international consensus that participation in cancer screening should be based on informed consent.3 ^{w3 w4} However, in countries with publicly funded screening, those responsible for the success of the programme are also those who provide the information. Herein lies a potential conflict of interest. High participation rates are pivotal to any screening programme, but information about potential harms may deter women from participation.

How many women understand the full implications of screening?

Credit: GARO/PHANIE/REX