Wednesday, October 26, 2011

FEAR: Breast screening 'does more harm than good'


A major review is underway into the NHS breast cancer screening programme, amid fears that it may do more harm than good.

An independent team is to look at research evidence and, at the very least, a much-criticised leaflet telling women about the benefits will be rewritten.
The review was announced by the cancer ‘czar’ Professor Sir Mike Richards after mounting controversy fuelled by studies claiming that screening does not save lives and may lead to unnecessary treatment.

It was brought to a head by an open letter from Professor Susan Bewley, consultant obstetrician at King's College London, in the British Medical Journal calling for women to be told of ‘genuine doubts’ about the programme.
She said NHS leaflets sent to women invited for screening ‘exaggerated benefits and did not spell out the risks’ despite being revised last year following criticisms.

She said there had been no proper scrutiny of the ‘oft repeated statement' that ‘1400 lives a year are saved'.
Under the £75million programme, women are invited for three-yearly mammograms, or X-rays, between the ages of 50 and 70 years. The age limits are being extended to 47-73.

Almost two million women in the UK are screened each year.

But researchers from the Nordic Cochrane Centre, who have repeatedly questioned the benefits of organised screening programmes, suggest the dramatic fall in breast cancer deaths in recent years is probably due to changes in risk factors and improved treatment.

In a study last year they found one in three breast cancers detected by screening may actually be harmless, meaning thousands of women are wrongly told they have life-threatening disease and undergo unnecessary treatment.

The Cochrane team’s latest research in March found little difference between the death rates of women given mammograms and those who did not have access to screening among 110,000 women studied in Denmark.

Prof Bewley’s letter to Prof Richards recalls how he said the ‘large majority of experts in this country disagrees with the methodology used in the Cochrane Centre reviews’.

But, she said, this argument ‘is inadequate and unpersuasive'.

She writes: ‘In the past few years, British women have not been told about the genuine doubts’ and warns that the new leaflet ‘is still not good enough'.

She says: ‘I am not convinced that you have challenged your experts competently and mercilessly, rather than hidden behind them.

'Thus I support the calls for an independent review of the evidence - a review that will not be kicked into the long grass, whose findings will be widely and properly disseminated, and that will adjust screening policy appropriately and will lead to proper pursuit of the research implications.’

In his reply, Prof Richards says he backs advice from UK and international experts that breast screening saves lives and does more good than harm.

But ‘the ongoing controversy should, if at all possible, be resolved’.

He pledged to put the findings of an independent review before ministers even if it concludes that ‘the balance of harms outweighs the benefits of breast screening'.
In addition, a new process for developing written information for the public about each screening programme will result in the breast screening leaflet being revised allowing them to make ‘truly informed choices'.

The latest leaflet says one breast cancer death is prevented for every 400 women screened for 10 years, but the Cochrane team says the true figure needed to screen is 2,000.

Professor Michael Baum, an international authority on breast cancer and screening sceptic, says for each woman whose life is saved, 10 healthy ones needlessly receive mastectomies and other treatment.

He said more research had emerged earlier this year showing the ‘trumpeted fall’ in breast cancer mortality attributed to screening is entirely due to improved treatment.

Prof Baum, who resigned from the NHS screening committee more than a decade ago to fight for women to be given a truly informed choice, welcomed the review but said it must be ‘genuinely independent’ and free of the ‘usual suspects'.

‘It’s an inescapable fact that the biggest effect on mortality is among women under 50 – who are not screened. There are alternative ways of saving lives’ he added.
A spokeswoman for the Department of Health 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.
‘Our screening programme has always been regularly scrutinised and evaluated.

'We know that some scientists differ in their views towards screening so in order to find consensus we have asked the National Cancer Director Professor Sir Mike Richards, to review the evidence in partnership with Harpal Kumar, Chief Executive of at Cancer Research UK.
‘We will look at the findings of the review.’


Source: MAIL ONLINE

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