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Breast screening information should be more balanced

The information sent to women about breast screening needs to be more balanced to ensure women are adequately informed about the benefits and harms, say researchers in this week's BMJ.

Invitations to screening mammography play a central part in the process of obtaining informed consent, but conflict of interest exists for publicly funded screening, since organisers want a high uptake. Research also shows that women generally exaggerate the benefits and are unaware of the harms of screening.

The researchers 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.

Thirty invitations (97%) mentioned the main benefit of screening, a reduction in breast cancer mortality, but only seven gave the size of the benefit and none of them in a helpful way. In contrast, no invitation mentioned the major harm of screening, over-diagnosis and subsequent over-treatment.

Six invitations argued that screening leads to less invasive surgery and another four stated that it leads to simpler treatment. None of the invitations noted that research has shown that screening leads to increased use of surgery and radiotherapy arising from over-diagnosis.

Fifteen invitations (48%) recommended regular breast self examinations, despite doubts over their benefit and documented harms.

Although it is good news that the invitations often included an information pamphlet, the focus on the benefits of screening is problematic, say the authors. The most important harms, over-diagnosis and over-treatment, were not mentioned and other important harms were often either omitted or downplayed.

Two-thirds (68%) of invitations gave an appointment date, but they warn that this gives the impression that participation is a public duty. They believe that information material should convey the message that
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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
2-Mar-2006


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