It is not wrong to say no

I have seen enough women die from breast cancer to know very clearly what a terrible disease it can be and to understand the motivation that drives attempts to promote early diagnosis and curative treatment. It is not possible to take this issue lightly, and yet I have cheerfully declined successive NHS invitations to attend for my own screening mammography. My worry is that I have made this decision on the basis of information that is not readily available to my patients.

In the United Kingdom each mammography invitation encloses the leaflet Breast Screening: The Facts, a title that in itself seems to deny any sense of the uncertainties permeating the programme. The unforgivable feature of this leaflet is that, despite protests and promises of improvement, it still emphasises only the benefits of screening and makes no mention of the possible harms. Yet every practising clinician knows that screening always produces harms as well as benefits. The reassuring tone of the leaflet conveys a clear expectation that any rational, socially …