Intended for healthcare professionals

Analysis And Comment Public health

Content of invitations for publicly funded screening mammography

BMJ 2006; 332 doi: (Published 02 March 2006) Cite this as: BMJ 2006;332:538
  1. Karsten Juhl Jørgensen, research fellow (,
  2. Peter C Gøtzsche, director1
  1. 1 Nordic Cochrane Centre, Rigshospitalet Department 7112, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
  1. Correspondence to: K J Jørgensen
  • Accepted 1 December 2005

The benefits and harms of screening for breast cancer are delicately balanced and women should decide for themselves, on an informed basis. Do the invitations give enough information to enable this?

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.

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How many women understand the full implications of screening?


What do women believe?

Women generally exaggerate the benefits and are unaware of the harms of screening.46 The authors of a study of American and European women4 raised doubts about informed consent procedures since 68% believed screening reduced their risk of contracting breast cancer, 62% that screening at least halved mortality, …

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