We thank Drs Khan and Gbolade for their interest in our article.1 They raise the question of whether level of educational attainment was correlated with participants’ level of understanding of the reasons for referral and the benefits of the management options. Although we did collect age at which participants left full-time education, it would not be appropriate to draw conclusions about correlations with ‘level of understanding’, given the qualitative nature of our study. Our concern in this study was in exploring the meanings that women themselves gave to their referral and attendance, and not in assessing whether their understanding was ‘correct’. Quantitative work would be required to determine whether there is any relationship between educational level and ‘understanding’, but we suspect that any relationship will be a weak one. The article by Kane et al. (2003) cited by Drs Khan and Gbolade concerns treatment selection in men with prostate cancer in the USA, and its relevance is not immediately evident. The study by Kane et al. notes the difficulty of dissociating educational achievement from other important variables and reports that educational attainment may be a weaker determinant of choice of treatment compared with other factors.