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
    +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 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
    +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.

 

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