Portfolio politics

Louise Newson (02/03/2009 09:41:00)

Is breast cancer screening really worthwhile?

mammography machine.jpg There has been a lot of adverse publicity in the newspapers recently about the harms of breast cancer screening. This has followed an article in the BMJ which recommends that the leaflet which is currently sent to each woman undergoing breast screening entitled “Breast Screening: The Facts” is abolished. The NHS Cancer Screening Programme has agreed that it is going to be re-written to include more of the potential harms of screening.

The major harm of screening is the unnecessary treatment of harmless lesions that would not have been identified without screening. This article in the BMJ has quoted the following facts about breast cancer screening:

If 2000 women are screened regularly for 10 years, one will benefit from the screening, as she will avoid dying from breast cancer.
At the same time, 10 healthy women will, as a consequence, become cancer patients and will be treated unnecessarily.

Combined with the higher levels of anxiety and stress that occur in women who have false positive mammography results, I am yet to be convinced of the true merits of breast cancer screening.
Would other women feel differently about attending for breast cancer screening if they were given all the facts – the benefits and the harms – from this screening programme?

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Comments [5]

Hammad Zaidi

Posted: 03/03/2009 10:06:23

It is true to some extent that it can create a false alarm. But overall i think breast screening is useful.

Annabel Bentley

Posted: 03/03/2009 14:43:14

Interesting post Louise, thank you.

Working out the numbers is where it gets interesting....

BMJ article from Gotzsche (Nordic Cochrane) says screening 50-70year olds saves 1 woman per 2000 screened over 10 yrs http://tinyurl.com/dd9a4j

But... could this number be 600% or 3000% wrong? Prof Wald (epidemiologist, Barts & London) thinks so. He's responded to the Gotzsche BMJ article with a calculation that:
- screening saves 6 women per 2000 screened over 10yrs
- and if women continued screening after 70years it would save 30 women per 2000 screened
- http://tinyurl.com/ak7ogl

Agree, women need balanced facts to make their own decision. But presently accurate, relevant information that women (and doctors!) understand is our challenge.

John Lalor

Posted: 03/03/2009 22:18:20

Very interesting.

I wonder if screening after seventy saves many patients who have a long healthy life ahead? Azheimers claims 1:4 at 80 so maybe they would feel differently knowing that they were being saved to lose their brains and become totally dependent?

Who knows, but 1/ 2000 lives saved demands the question is it all worth it - if a further 10/2000 are terrified and misdiagnosed?

I think it should be abolished. It also causes women with breast cancer to be falsely reassured - false negatives. A patient of mine died 16 months after a normal mammogram

Too many interested parties who would stand to lose a fortune though for that to happen.

Katharine Morrison

Posted: 04/03/2009 07:30:18

There have been other articles and papers over the years pointing out the poor returns for mammography, continued risk of inteval cancers and the harms from false postives and unnecessary treatmeent.

Balanced information will help women make the best choice for them regarding screening.

Prevention of breast and other cancers from vitamin d supplementation of the population and would be relatively inexpensive (About £30 a year). This, if started early enough, would also be expected to greatly lessen the incidence of type one diabetes and multiple sclerosis and other autoimmune disease and even cardiovascular disease.

Radiotherapy courses are extremely tiring. The provision of home help during this time for those who need it would greatly ease the burden.

Both of these measures are in my opinion a much better use of money than breast screening has ever been.

Preenal Shah

Posted: 15/03/2009 21:30:58

two recent family members have been diagnosed with breast cancer, thankfully picked up by the screening programme. Telling them it not's worth it.... I don't think so

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Louise Newson

Louise is a part-time salaried GP in Solihull, West Midlands. She works four sessions a week for a large suburban practice. She also works at the local hospice and has a keen interest in palliative care. She is also interested in evidence-based medicine, predominately in chronic diseases, and teenage health. She writes for numerous other medical publications and also contributes to patient information leaflets on www.patient.co.uk. She is married to a surgeon who is currently working ridiculous hours meaning that childcare (they have 5 and 4 year old girls) and all household duties are completely her responsibility! She finds work/life balance a constant struggle.

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Is breast cancer screening really worthwhile?

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Comments [5]

Hammad Zaidi

Posted: 03/03/2009 10:06:23

Annabel Bentley

Posted: 03/03/2009 14:43:14

John Lalor

Posted: 03/03/2009 22:18:20

Katharine Morrison

Posted: 04/03/2009 07:30:18

Preenal Shah

Posted: 15/03/2009 21:30:58

Louise Newson

Previous posts

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Is breast cancer screening really worthwhile?

Tell a colleague

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Comments [5]

Hammad Zaidi Posted: 03/03/2009 10:06:23

Annabel Bentley Posted: 03/03/2009 14:43:14

John Lalor Posted: 03/03/2009 22:18:20

Katharine Morrison Posted: 04/03/2009 07:30:18

Preenal Shah Posted: 15/03/2009 21:30:58

Louise Newson

Hammad Zaidi

Posted: 03/03/2009 10:06:23

Annabel Bentley

Posted: 03/03/2009 14:43:14

John Lalor

Posted: 03/03/2009 22:18:20

Katharine Morrison

Posted: 04/03/2009 07:30:18

Preenal Shah

Posted: 15/03/2009 21:30:58