Informed choice and breast cancer screening.
It is an accepted principle of clinical practice that any intervention should be preceded by informed consent demonstrating that the individual understands both the potential benefits and harms of that intervention. I believe that this principle has been neglected when women are invited for mammographic screening. Public health agencies promote screening as an unequivocal 'good' by publicizing the benefit in mortality reduction in relative terms and avoiding discussion of potential harms. Each woman is encouraged to believe that, whatever the outcome of her individual screening experience, she has in some way benefited. I believe that the harm:benefit margins for screening are finely balanced and that the individual woman should be able to make an informed choice based on the balance of benefit versus harm for an individual, rather than for the total population of women in the screening age group.
Baum
Michael
M
The Portland Hospital, Great Portland Street, London, W1N 6AH, UK. Michael@mbaum.freeserve.co.uk.