McPherson's article is thoughtful, informative, and seems to be dispassionate.1 The degree of benefit or harm of breast screening is unknown. Women should be told this on their screening invitation and asked if they would consentto being randomised to screening or no screening within a trial. This would not be the first time that a "mega-trial" was needed to sort out conflicting results from smaller trials and combined results. Randomisation by different GP practices as has been used in some studies is laughably inadequate. A pure randomised trial is needed. At least some women might be considerably annoyed not to be given such an option.
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