(This commentary was not written by CRD, but by the authors of the DH Register.) 1) The paper states the importance of considering costs and benefits to all screened women (not just true positives) but then models only improved life expectancy in the true positives. 2) Non-compliance is not discussed. 3) Gains in survival are not detailed and so the findings are questionable. The model assumes that cancers number the same under screening and conventional care, because of variable natural history and competing causes of death this is unlikely.