Breast screening: the facts—or maybe not

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b86 (Published 27 January 2009)
Cite this as: BMJ 2009;338:b86

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  1. Peter C Gøtzsche, director1,
  2. Ole J Hartling, consultant2,
  3. Margrethe Nielsen, PhD student1,
  4. John Brodersen, lecturer3,
  5. Karsten Juhl Jørgensen, researcher1
  1. 1Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
  2. 2Department of Nuclear Medicine, Vejle Sygehus, Denmark
  3. 3Department of General Practice, University of Copenhagen, Denmark
  1. Correspondence to: P C Gøtzsche pcg{at}cochrane.dk
  • Accepted 23 October 2008

Peter Gøtzsche and colleagues argue that women are still not given enough, nor correct, information about the harms of screening

Three years ago, we published a survey of the information given to women invited for breast screening with mammography in six countries with publicly funded screening programmes.1 The major harm of screening, which is overdiagnosis and subsequent overtreatment of healthy women, was not mentioned in any of 31 invitations.1 Ten invitations argued that screening either leads to less invasive surgery or simpler treatment, although it actually results in 30% more surgery, 20% more mastectomies, and more use of radiotherapy2 because of overdiagnosis.3 4 Pain caused by the procedure was mentioned in 15 invitations, although it is probably the least serious harm, as it is transient.

Since then, little has changed. Our 2006 article included a box with recommended information and numbers needed to benefit and to harm.1 Although the information leaflet used in the United Kingdom has since been updated,5 the contents remain essentially the same. The leaflet has the authoritative title Breast Screening: the Facts,5 suggesting that the information can be trusted. Here, we discuss why it is inadequate as a basis for informed consent and introduce our leaflet, which we think provides the information on the benefits and harms of breast screening that women need to make a rational decision.

Problems with UK leaflet

The revised leaflet emphasises the benefits of screening. The first page leaves no doubt that screening is good for women, with its second heading: “Why do I need breast screening?” Furthermore, it states, “If changes are found at an early stage, there is a good chance of a successful recovery, ” and “Around half the cancers that are found at screening are still small ... This means that the whole …

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