Women need better information about routine mammography

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Abstract
Scientists continue to argue about the benefits of breast screening, but ultimately decisions about screening should be made by women themselves. To make this decision, however, women need to fully understand both the benefits and the potential harms Although mammographic screening is well established in the United Kingdom and elsewhere, its value continues to be debated. Most of the data on mammographic screening come from a group of clinical trials completed over a decade ago. These are subject to constant reworking, reanalyses, and wrangling between the screening zealots and the screening sceptics. New data are unlikely to emerge, as it is improbable that new screening trials, with a control group that is “left to nature” will be conducted. ![][1] Decisions about mammographic screening should be based on all the facts Credit: CHRIS PRIEST/SPL Most of the controversy surrounding screening, however, seems to miss the point. The question of whether the benefits of screening outweigh the harms is essentially a value judgment. The problem is that, up to now, this judgment has been made by paternalistic agents of the state rather than by women, supported by their general practitioners or others. In order to make an informed choice on screening, women need to be aware of the range of uncertainties for both the benefits (that is, preventing death from breast cancer) and the harms. Public health programmes such as the UK NHS breast screening programme aim to reduce mortality from breast cancer by offering routine mammography to healthy individuals. This is a potential public good. But the public receives highly conflicting messages about the effect of screening. Every new published estimate is hotly debated in the media, and the results are usually couched in terms that most people will misunderstand. The latest report of a “44% reduction in breast cancer mortality in … [1]: /embed/graphic-1.gif