Dear Susan

Your letter raises several important issues. These include the current state of the evidence relating to the benefits and harms of breast screening; how this information is communicated to women in order to promote informed choice; and the process by which decisions on screening are made in this country, including my own role. I welcome this opportunity to discuss all these issues.

When I became national cancer director 12 years ago the NHS breast screening programme was one of the few aspects of cancer service delivery that was generally judged to be working well. Broad decisions on screening programmes were, and still are, taken by the independent UK National Screening Committee, which advises ministers in all four UK countries. …