Letters “Citizens’ jury” on screening leaflet

Any conclusion from this “citizens’ jury” will be seriously flawed

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8576 (Published 21 December 2012) Cite this as: BMJ 2012;345:e8576
  1. Paul Pharoah, public health doctor1
  1. 1Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK
  1. paul.pharoah{at}medschl.cam.ac.uk

Although we shouldn’t prejudge the outcome of the citizens’ jury’s deliberations, Hawkes’s report of the process suggests that any conclusion will be seriously flawed.1 He states that “There was agreement, though the question was not put to a vote, that the leaflet should begin by citing the numbers of lives saved by breast cancer screening, 1300 a year according to the Marmot review.” This suggests that the jury had been informed that breast cancer screening saves lives. There is no evidence that it does, and this conclusion in the Marmot report is a serious flaw in the reporting of the results.

No randomised trial of breast cancer screening has shown a reduction in all cause mortality. The Marmot review chose not to evaluate all cause mortality as an endpoint, even though overtreatment is bound to increase deaths from other causes. So, if the leaflet is to open with a statement about lives saved it should state that the best evidence suggests that no lives are saved by breast cancer screening. Would the jury still have chosen this option if it had been accurately informed of the available data. Given this serious flaw in the information offered to the jury, the whole process is questionable and likely to be invalid.


Cite this as: BMJ 2012;345:e8576


  • Competing interests: None declared.