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Mike Richards, national clinical director for cancer and end of life care, Department of Health, London

Mike.Richards{at}ncat.nhs.uk

The BMJ has published several articles over the past few years raising concerns about the accuracy and transparency of information provided to women about the benefits and harms of mammography screening for breast cancer (BMJ 2006;332:538, doi:10.1136/bmj.332.7540.538; 2009;338:b86, doi:10.1136/bmj.b86; 2010;340:c3106, doi:10.1136/bmj.c3106). Last month the professor of complex obstetrics Susan Bewley sent us for publication an open letter to England’s cancer tsar (BMJ 2011;343:d6894, doi:10.1136/bmj.d6894). Here is the response from Mike Richards

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. …