Breast cancer screening under review

 

Professor Mike Richards: 'Screening can diagnose cases that would never have caused trouble during a woman's lifetime'

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The evidence for breast cancer screening in the UK is being reviewed amid controversy about the measure's effectiveness.

The NHS says screening saves lives, but other researchers have argued that it may cause more harm than good.

The national cancer director for England, Prof Mike Richards, announced in the British Medical Journal that he will lead a review.

He said he was taking the "current controversy very seriously".

When it comes to cancer treatment, earlier is better. Screening programmes for a range of cancers help doctors make a diagnosis sooner. But they also run the risk of false positives, diagnosing someone with cancer when they are healthy.

Life saving

Screening was introduced for breast cancer in 1988 in the UK and now offers tests to women, over the age of 50, every three years.

In 2002, the World Health Organization's International Agency for Research on Cancer estimated that screening reduced deaths from breast cancer by about 35%.

The NHS says 1,400 lives are saved through screening in England alone.

Breast screening: the debate

  • 1988: UK women over 50 first offered screening every 3 years
  • 2002: World Health Organization estimates screening reduces deaths by about a third
  • Jan 2011: Review of large clinical trials questions whether screening does more good than harm. It says for every 2,000 women screened, 1 life would be saved, 10 women would have treatment they don't need and 200 would face stress of false positive results
  • Oct 2011: Government cancer expert announces review of evidence.
  • Oct 2011: Department of Health says their advice is unchanged and urge all women to go to screening when invited

However, the evidence has been questioned.

A review of clinical trials involving a total of 600,000 women concluded it was "not clear whether screening does more good than harm".

It said that for every 2,000 women screened in a 10-year period: one life would be saved, 10 healthy women would have unnecessary treatment and at least 200 women would face psychological distress for many months because of false positive results.

The authors of that research labelled the NHS Breast Screening Programme's advice "seriously misleading".

Professor of complex obstetrics at King's College London, Susan Bewley, has turned down screening.

Exchange

In a letter to Prof Richards last month, she said: "The distress of overdiagnosis and decision making when finding lesions that might, or might not, be cancer that might, or might not, require mutilating surgery is increasingly being exposed."

In response, Prof Richards said research suggested that up to two and a half lives were saved for every over-diagnosed case.

He added that he would lead a review of the evidence to settle the ongoing controversy.

"Should the independent review conclude that the balance of harms outweighs the benefits of breast screening, I will have no hesitation in referring the findings to the UK National Screening Committee and then ministers.

Mammogram Mammograms can identify tumours before they would be picked up

"I am fully committed to the public being given information in a format... that enables them to make truly informed choices."

A Department of Health spokesperson said: "Our advice has not changed - we urge all women to go for breast screening when invited.

"The best available evidence shows that screening saves lives by detecting cancers earlier than they would otherwise have been. "

Prof Julietta Patnick, director of the NHS Cancer Screening Programmes, welcomed the review: "The NHS Breast Screening Programme has always been based on the best and latest evidence.

"Where new information has suggested them, a number of changes have been made to the Programme, for example extending the screening age range and using digital mammography."

The review will be led jointly by Prof Richards and Cancer Research UK.

The director of health information at the charity, Sara Hiom, said: "Women need more accurate, evidence-based and clear information to be able to make an informed choice about breast screening.

"The decision whether to be screened is a personal one, but that decision should be made with all of the potential harms and benefits fully explained."

Breakthrough Breast Cancer's chief executive Chris Askew said: "Breast screening is vital as it can detect breast cancer at the earliest possible stages when no other symptoms are obvious.

"The current debate over the pros and cons of screening may be very confusing for women and so we welcome this review. We hope it will mean women are reassured that all the evidence has been considered and the information they receive is accurate and balanced."

 

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  • rate this
    0

    Comment number 55.

    People also need to be aware that mammograms do NOT show every tumour. Women are NOT informed of this, so risk ignoring or not checking for abnormalities after their scan. This is WRONG. Mum had a scan in spring 2010, found a lump, put it off until autumn 2010, it was cancer, she made a full recovery but it had spread, she passed away suddenly Sept 2011. The cancer still did not show on scans.

  • rate this
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    Comment number 54.

    Mike Richards is right to review this. With screening for any medical conditions there will be winners and losers. Winners are those where the cancer was diagnosed early and cured. Losers are those with 'suspicious findings' who go on to have invasive procedures/mutilating surgery only to find no cancer. 'Lead time' bias is a major confounder. Then there are interest groups making money out of it

  • rate this
    0

    Comment number 53.

    It is not about equality and spending equal amounts of money on men and women, its about spending the money where the medicine is accessed.

    If more men accessed healthcare for prostate exams for example then more money would be put into it. What would be the point in putting millions into a Prostate Cancer campaign until the Government are sure there will be worthy support from men?

  • rate this
    0

    Comment number 52.

    I have just completed treatment for breast cancer, found myself, as I am a few years too young to be included in the screening programme. If screening were available younger I might have had less drastic treatment. All the argument about false positives ignores the patient's view - we need good info, a screen, and then it's up to us whether "over treatment" is "bad". No screen - no view possible.

  • rate this
    -2

    Comment number 51.

    Major-minor has got me thinking! I don't think nearly enough is being done for women under age 50. They need much better recognition. What about a self-referral system for all women regardless of age? Give us the choice. My misdiagnosis must have cost the NHS a fortune. Had I been caught earlier I may have needed only radiotherapy, instead I've had the lot and scarred for life because of it.

  • rate this
    0

    Comment number 50.

    some simple statistics. 12,000 women a year die of breast cancer in the UK, for prostate cancer it is 10,000. Money spent on each by the UK, for every pound spent on Prostate cancer screening, research and treatment, one would expect about £1.20 to be spent on Breast cancer. Reality ? £16 is spent on breast cancer for every £1 on prostate cancer, a good example of equality in action?

  • rate this
    +1

    Comment number 49.

    I have recently been diagnosed with breast cancer via the breast screening programme, I had no clue that I had a 5cm tumour and so treatment has started in time. I realise that some people are distressed about various alarms, but this calls for two things. The programme to be regularly reviewed so that false alarms are fewer, and people being educated about how results may not be definitive.

  • rate this
    +1

    Comment number 48.

    I am a little confused by this. My wife has had breast cancer twice, but it has been the biopsy following the mammogram which has diagnosed the cancer, not the mammogram itself, as there is no way of telling from the mammogram whether the tumour is benign or malignant. She owes her life to it being detected early by the mammogram.

  • rate this
    +1

    Comment number 47.

    I can't believe this stuff about breast screening. My breast cancer was caught on my first routine breast screening 3 years ago. There was no lump. It was hidden deep in my breast and was not palpable. It was larger than 2 cm and had already spread to lymph nodes. I am here today alive and well. Without the early detection and prompt treatments , I don't know where I would be now.

  • rate this
    0

    Comment number 46.

    Breakthrough Breast Cancer's chief executive Chris Askew's reference to "the one in eight women who are diagnosed every year with this disease" is wrong by a factor of 80. The yearly incidence is about one in 700. The one in 8 figure is the chance that a woman will be diagnosed at some time in her life (NOT "every year"). Slip of the tongue or "useful" scary number? I could not possibly comment!

  • rate this
    0

    Comment number 45.

    We need to know the truth about screening but who do we believe? I nearly died because my GPs did not refer me at age 46 for further investigation when showing obvious signs which could have been breast cancer. Screening at age 50 saved my life albeit at a much more advanced stage. It was the GPs that nearly finished me off. Serious dereliction of duty on their part. Beware of GPs ignorance.

  • rate this
    +3

    Comment number 44.

    "The earlier breast cancer is picked up the better for the one in eight women who are diagnosed every year with this disease"

    This is a VERY important error in this article. One in eight women will develop breast cancer over a lifetime. One in eight DO NOT develop breast cancer each year.

  • rate this
    0

    Comment number 43.

    There may be arguments related to the numbers of false positives compared to the number of lives saved but I believe that the reason behind the review is the same as the reason behind many other reviews ... cold hard cash.

  • rate this
    -2

    Comment number 42.

    "It said that for every 2,000 women screened in a 10-year period: one life would be saved, ..."

    What on Earth does that mean? Why mention a 10-year period? It is just "for every 2,000 women screened", surely?

  • rate this
    +1

    Comment number 41.

    I was diagnosed with breast cancer at 46 years old, before mammograms are deemed to be appropriate. I had to have three lots of surgery, chemo therapy, radiotherapy and finally breast re-construction. I'm sure this cost the NHS a hell of a lot more than a simple mammogram would have done if my cancer had been picked up earlier. Mammograms should be routine for all women, not just over 50s.

  • rate this
    0

    Comment number 40.

    Surely the right response to this is to give women accurate information and then let them make their own choices. ie still send out letters calling them to a screening, as now, but explain the figures, the false positives, and the risk of unnecessary treatment. Then women can make up their minds themselves.

  • rate this
    0

    Comment number 39.

    Neither the surgeon nor I could feel anything, however, the cancer had spread to a couple of the lymph nodes. If I had not had a routine mammogram how far would it have spread before I knew about it? Keep screening please. I agree with the need for male screening schemes, but the fact they don't exist yet, doesn't nulify the need for breast screening.

  • rate this
    +1

    Comment number 38.

    I was diagnosed with breast cancer in February, following a mammogram. I owe more than I can say to the fact that it was caught early, as prompt treatment meant that I am well now.

  • rate this
    +2

    Comment number 37.

    Suzy1968, There are now FAR more accurate tests than just the old fashioned PSA for prostate cancer. PCA3 tests exist but are more costly and of course, men don' merit any money being spent on then as we all know. The usual excuses are churned out without anyone checking the facts.

  • rate this
    +2

    Comment number 36.

    I was saved by the regular 50+ screening, i was found to have extensive DCIS and had to have an immediate mastectomy as you can imagine this was a traumatic time and still is as it was less than 2 years ago. I feel that i am now being told i should have waited to see if it became invasive first.
    Screening is saving more women than it is harming.

 

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