Breast cancer: reduction in deaths due treatment, not screening

Reduction in breast cancer deaths due to treatment, not screening, finds study in New England Journal of Medicine:

with responses:


Posted in Breast Cancer, breast screening, Campaigns, clinical trials, healthcare modernisation, information, informed consent, mastectomy, Over-medicalisation, overdiagnosis, overtreatment, patient safety, Public safety, Screening Mammography, Uncategorized | Tagged , , , , | Leave a comment

Breast cancer, tumour size, screening effectiveness – NEJM

October is with us again. Unfortunately, it has been painted pink. This month cancer charities and others gear up to urge women to attend breast screening as the best means of avoiding death from this disease. Sadly, these well-meaning messages are inaccurate and patently false because they are based on out-dated information.

Medical understanding of breast cancers has moved on from believing ‘find it small and it will save your life’. It just does not work like that: small cancers found by screening may never grow larger or be a problem in a lifetime, whereas larger cancers may grow rapidly and take lives – or vice versa – the problem is no-one can identify which will be killers. So breast screening of healthy women (ie without breast symptoms) finds thousands of ‘changes’, some of which will be harmless, but will nevertheless go on to be treated. This is ‘overdiagnosis’ (different from the ‘false positive’ results, when women are mistakenly told they have cancer) – see earlier links to many research papers.

Contrary to what was thought in the past, “finding it ‘early’ (ie ‘small’ – how can anyone know how early…? ) will save your life” turns out not to be the case. So why do breast screening programmes continue when there is now an accumulation of robust research which shows screening (as opposed to diagnostic imaging when someone has symptoms) actually causes more harm than benefit, if any?

Breast-Cancer Tumor Size, Overdiagnosis, and Mammography Screening Effectiveness

H. Gilbert Welch, M.D., M.P.H., Philip C. Prorok, Ph.D., A. James O’Malley, Ph.D., and Barnett S. Kramer, M.D., M.P.H.

N Engl J Med 2016; 375:1438-1447October 13, 2016

Posted in Breast Cancer, breast screening, Campaigns, cancer, citizen safety, guidelines, healthcare modernisation, informed consent, mastectomy, openness, Over-medicalisation, overdiagnosis, overtreatment, patient safety, patient/doctor communication, Public safety, Screening, Screening Mammography, Uncategorized | Tagged , , , , | Leave a comment

Website support for nurses

Inspirational quotes to help nurses get through the  day – read more here:

and you can also suggest your own quote.


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Breast screening – revised estimates of overdiagnosis

Cornelia Baines and colleagues have re-estimated overdiagnosis of breast cancer from mammography screening by age group in the Canadian National Breast Screening Study (CNBSS) – a randomized screening trial.

They found ‘substantial overdiagnosis in the CNBSS with estimates that are consistent with other robust published estimates’ and say what is needed is ‘a rigorous definition of the histological criteria of overdiagnosis’ as well as ‘effective methods for communicating the risk of over-diagnosis to policy-makers, the medical profession and the public’.

Their conclusions show high levels of overdiagnosis in both age groups studied (‘approximately 30% of invasive screen-detected breast cancers in women aged 40-49 were overdiagnosed… 20%… aged 50-59’ – ‘Including ductal carcinoma in situ the estimates are 40% and 30% respectively’).

They state, ‘women should be completely informed of the risks of overdiagnosis before they decide to accept breast screening’.

Perhaps all women invited to breast screening should be given a copy of this paper.

Revised estimates of overdiagnosis from the Canadian National Breast Screening Study. Cornelia J Baines, Teresa To, Anthony B Miller. Preventive Medicine. 90 (2016) 66-71.

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Brexit: BMJ Editor’s Choice explains why not

‘Our intention was to remain scrupulously even handed. But as the series progressed we concluded that the arguments for remaining in the EU were overwhelming and that now was not the time for balance (doi:10.1136/bmj.i3302). We’re not alone: no prominent UK medical, research, or health organisation has sided with Brexit.’

Should I stay, or should I go now? Tony Delamothe, Deputy Editor. BMJ 2016;353:i3337

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60 Eminent Doctors warn re Brexit

A letter to the Times from former presidents and chairs of medical royal colleges and the BMA sets out why the UK should remain in the EU.

They concluded:

“It is Brexit that is the threat to the NHS, not our membership of the EU.”

‘Brexit – not EU membership – threatens the NHS, 60 eminent doctors say’.

Zosia Kmietowicz. BMJ 2016;353:i3373

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Shared decision-making and understanding research

The doctor’s role in communicating benefits and harms of treatments and how best to use research evidence to judge these, and so enable shared decision-making, is discussed by Fiona Godlee in ‘Start Stopping Smartly, BMJ’s Editor’s Choice, 9 June 2016.

The responses are interesting too, one with a reminder of that superb book, ‘Less Medicine, More Health’, by Dr H Gilbert Welch.

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