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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, et al. 343:doi:10.1136/bmj.d4411
I've recently contributed a response to the bmj blog of Richard Smith, former bmj editor:
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
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
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...
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