Objective: Despite the difficulties, there is a moral responsibility to provide the public with the best estimates of benefits and harms of breast cancer screening.
Methods: In this paper we review the issues in communication of benefits and harms of medical interventions and discuss these in terms of the principles of the balance sheet proposed in this supplement.
Results: The balance sheet can be seen as a tool to convey estimates based on the best available evidence and addressed to a readership wider than just potential screening participants. It reflects a re-assessment of screening efficacy, showing again that screening is effective and brings more benefits than harms. It can be viewed as an opportunity to re-affirm some basic principles of good evidence-based communication. Further research is needed to improve communication strategy, to assess the impact of this communication on women's awareness and to evaluate its utility in the informed decision-making process.
Conclusion: The balance sheet could be a starting point for a broader vision of informed decision-making in screening, which should also recognize the role played by 'non-numerical' factors on women's choice of participating in breast cancer screening.