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Anyone undergoing a screening test should give informed consent. The risks and benefits of the tests, including the consequences of testing should be provided. For example, men undergoing the PSA blood test for prostate cancer, should understand that if it is positive they may also have a transrectal biopsy, which has its own side-effects and complications. The risks extend beyond physical concerns. People who have false positive results in a screening program can have increased anxiety, or ‘labeling’ effects. People who have false negative results can have false reassurance. Note that these effects are carried by individuals who do not necessarily benefit from the screening program. Those instituting a screening program must pay particular attention to distributive justice issues. Population-based screening programs should be freely available to all those in the target population.