Intended for healthcare professionals

Observations The Art of Risk Communication

Breast cancer screening pamphlets mislead women

BMJ 2014; 348 doi: (Published 25 April 2014) Cite this as: BMJ 2014;348:g2636
  1. Gerd Gigerenzer, director
  1. 1Harding Center for Risk Literacy and Centre for Adaptive Behaviour and Cognition, Max Planck Institute for Human Development, Berlin, Germany
  1. gigerenzer{at}

All women and women’s organisations should tear up the pink ribbons and campaign for honest information

Why should I have mammography? That question is regularly asked in pamphlets for screening. The answer is also regularly misleading. Women are told what they should do, but without being given the facts necessary to make informed decisions. This form of paternalism has a long tradition. In a campaign poster in the 1980s, the American Cancer Society declared: “If you haven’t had a mammogram, you need more than your breasts examined.”

As a result of paternalism and pink ribbon culture, almost all women have a false impression of the benefit of mammography screening. For instance, 98% of women in France, Germany, and the Netherlands overestimated its benefit by a factor of 10, 100, or more, or did not know.1 Most surprisingly, those who frequently consulted their physicians and health pamphlets were slightly worse informed. Russian women gave the most realistic estimates among those in nine European countries studied—not because they have more information at their disposal but because there are fewer misleading pink ribbon pamphlets in Russia.

Misinformation needs to stop. All pamphlets should show a “fact box” that explains benefits and harms in a transparent way.2 The figure shows one based on the most recent Cochrane review for women age 50 to 69.3

In sum, the absolute …

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