to screen or not to screen?

3 minute read time.

Like most people, I used to think screening for breast cancer was a good thing. Finding cancer 'early' meant it would be small, so could be taken out with minimum treatment and your life was more likely to be saved than if it had grown and spread. Commonsense?

Not so. I've been following the recent research and articles on breast screening over the past two years (even contributing in a small way) because all is not as it seems.  Modern screening mammography finds extremely small 'changes'  that may never become cancer, but these are treated, mainly with mastectomy.

After a letter to The Times in February 2009 from eminent breast surgeons, epidemiologists, researchers etc the NHS Breast Screening Service (eventually) changed the information given to women invited for screening. But it still fails to give the whole picture - the SCALE of unnecessary harm - that research has shown breast screening actually causes more harm than benefit - although each page is now scattered with pretty flowers. And it still quotes 'numbers of lives saved' (by screening) although without a research reference to back the figures. However, here is recent research which shows screening's true effect on mortality.

Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database. Autier 343:doi:10.1136/bmj.d4411

I've recently contributed a response to the bmj blog of Richard Smith, former bmj editor:

http://blogs.bmj.com/bmj/2011/08/01/richard-smith-my-vain-search-for-a-pro-mammography-speaker/?utm_source=feedbur

There's so much I could post here which shows screening mammography (as opposed to diagnostic mammography used to investigate breast problems) needs to be independently re-assessed.

Here's another article: Let's get frank about breast screening, Cornelia Baines

>http://www.openmedicine.ca/article/view/461/416

Re finding breast cancer early - how can you know when it began to grow? Small is not necessarily good - some breast cancers are more aggressive than others and grow more quickly. Treatment may actually provoke a cancer to grow and can also cause more cancers. It's all a matter of harm benefit ratio - and women need full information in order to weigh the risk and decide for themselves whether screening is right for them. Yes, FULL information. There is now a call for an judicial review of the breast screening programme and a call for an independent body of people to write the information offered to women. Those with vested interests should not decide how much information women want or need.(See The Sunday Times, 31 July 2011, M Baum et al)

Breast cancer charities have successfully lobbied Ministers to increase the screening age at both ends. But they are not willing to discuss recent research. It takes an open mind to look at evidence against what you know (by instinct?)

I believe the present screening programme to be unethical for the following reasons:

Beneficence – it is not beneficial (Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database, Philippe Autier et al, BMJ 2011; 343:d4411)

The claim it saves lives is not properly referenced.

Nonmaleficence – it can cause harm by anxiety, investigations, overdiagnosis, and unnecessary surgery and other ‘treatments’ (with major lifelong side effects).

Autonomy – the written information offered is not independent: women should be told the full facts and they are not.

Justice – the money could be better spent elsewhere.

See also the General Medical Council’s Consent Guidance.

I've just received an invitation to mammography screening because I am in the now extended age range. I declined - but I made a fully informed decision. I also objected to the fact I was sent an unsolicited appointment, which put the onus on me to reply, knowing if I did not attend my medical record would be labelled  DNA (did not attend). If women were really given FULL informtion (and signposted to unbiased recent research findings etc) they could contact the screening service to make an appointment if they so wished. Invitations to cervical screening could also be seen as coercive in this way and are likely to affect the GP doctor/patient relationship adversely since the GP seeks compliance - and wants to recruit the required percentage of women...

Women need healthcare based on up to date research and facts please. They prefer not to be told what is best for them, but to evaluate and decide for themselves.

I'll post more later - am on granny duty and can hear cool baby coos...

Anonymous
  • FormerMember
    FormerMember

    Mitzi,

    It's so nice to find an informed woman who's taken the time to do some research. It shocks and concerns me that few women understand the real facts behind cancer screening - we're basically fed propaganda or at least, heavily biased pro-screening messages and ordered to screen. The entire emphasis is on screening women to achieve govt-set targets to justify expensive screening programs.

    There are so many vested interests ($$$) in these programs and they're also highly political and emotive. We're not supposed to question, just comply....

    I've lost count of the number of research studies conducted on why some women don't have screening - we're either uneducated, non-voters (I kid you not!), immature, sexual assault victims, ignorant etc

    It never occurs to them that perhaps women have simply decided not to have an "elective" cancer screening test.

    Why the anger and moral outrage when a woman chooses not to screen?

    I think these programs are actually quite frightening - the way they manipulate and mislead women and turn women onto each other - it kept non-screeners silent for many years. Thankfully, that's changing, but very slowly in Australia, where there is zero respect for informed consent for women. Few women are aware of the actual facts about screening. There are no prominent advocates for informed consent for women in this country, so they don't even need to address our concerns. The Cancer Council still use outdated "angles" to put screening in the best light - they can't even be bothered to think up new ones - they still argue that we have less cervical cancer than Africa BECAUSE we have screening...of course, this is very misleading - you cannot compare African women with Australian - the former have unique risk factors which means their rates have always been higher - if they were right, our rates of cc would match African rates in pre-screening days - nonsense - cervical cancer was always a rare cancer here and in natural decline before screening started and there are no randomized controlled trials for pap testing - if anyone is helped, it's fewer than 0.45% and we send 77% of women at some stage for colposcopy and usually some sort of biopsy to "possibly" help very few - that's massive over-detection and over-treatment....and all with no informed consent.

    The Breast Screen brochure does not even attempt to inform women. The last time I checked it did not even mention over-diagnosis. No one warns women about these omissions...no one seems to care - it's almost a silent conspiracy.

    Thankfully, I got to the facts and have declined cervical and breast cancer screening.