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.

http://www.ncbi.nlm.nih.gov/pubmed/27374944

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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

http://www.bmj.com/content/353/bmj.i3337?etoc=

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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

http://www.bmj.com/content/353/bmj.i3373?etoc=

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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.

http://www.bmj.com/content/353/bmj.i3209?etoc=

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Breast screening: ductal carcinoma in situ and overdiagnosis

 

Women who want to know more about breast screening (in particular the diagnosis of DCIS) and who value evidence rather than wishful thinking, may appreciate this article by Hazel Thornton:

Ductal Carcinoma in Situ: The Costly Folly of Overdiagnosis. Ed. Ruth Armstrong, Croakey Blog, 15 June 2016. (Open access.)

https://croakey.org/ductal-carcinoma-in-situ-the-costly-folly-of-overdiagnosis

Posted in breast screening, healthcare modernisation, Over-medicalisation, overdiagnosis, overtreatment, Screening, Screening Mammography | Tagged , , , | Leave a comment

Screening asymptomatic citizens and expanding disease definitions

In their bmj article of 9th May 2016, ‘“Informed Choice” in a time of too much medicine – no panacea for ethical difficulties’, Minna Johannson and colleagues discuss issues of patient autonomy and over-medicalisation; they illustrate the dangers of diagnostic ‘cascade’ (where one test leads to eg a series of tests or interventions) and explain how ‘preventive medicine and expanding disease definitions have changed the ethical premises of informed choice’ and can lead to overmedicalisation.

They warn: ‘informed choice implicitly suggests that information is inherently good’, however: ‘in medical reality, the choice is often undermined by biased information giving weight to the potential benefits and downplaying the risk of harm from false positive results and overdiagnosis’.

“Informed Choice” in a time of too much medicine – no panacea for ethical difficulties. Minna Johannson, Karsten Juhl Jorgensen, Lynn Getz, Ray Moynihan

BMJ 2016;353:i2230

http://www.bmj.com/content/353/bmj.i2230?etoc=

Posted in Breast Cancer, breast screening, Campaigns, citizen safety, Compassion in healthcare, harms, healthcare modernisation, information, informed consent, medicine's flaws, Over-medicalisation, overdiagnosis, overtreatment, patient safety, patient/doctor communication, personal autonomy, Public safety, rarer and uncommon cancers, Screening, Screening Mammography, screening prostate cancer | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Screening – most media articles skewed in favour

This study investigated whether coverage of cancer screening by national newspapers gives a balanced account of the possible benefits and harms of screening. The interesting results are produced in attractive graphic (pictorial/comic strip) form.

( With regard to breast screening: despite a huge accumulation of evidence showing harms of breast screening outweigh benefits, including results of the UK Independent Review, few women I meet seem aware of this, or have any understanding of ‘overdiagnosis’ – ‘detection of a cancerous lesion through screening that would otherwise not have caused any symptoms or early death’ – (Welch HG, Black WC. Overdiagnosis in Cancer, J Natl Cancer Inst 2010). And no wonder!

This ignorance of the harms, and unjustified view of the benefits of breast screening is not surprising since few lay women regularly access medical journals: the public relies on information in the national press and from the NHS Breast Screening Programme. For years we have been told ‘screening saves lives’. Despite new understanding of breast cancer, and despite all the research evidence which shows lack of benefit and level of harms, it must be very difficult to scrap that message and offer a truthful picture, especially when jobs and a whole industry is dependent on sufficient numbers of women being screened. So how can women who do not have access to full information make an informed decision about participation in breast screening programmes – ie regular screening of women who have no breast symptoms?)

Of the types of cancer articles investigated, only articles on prostate cancer were skewed towards harm.

The study concluded:

‘Newspaper articles emphasise the benefits of screening, while rarely giving balanced account of the potential benefits and harms. Coverage of overdiagnosis is limited.’

Annals graphic Medicine: Living on Benefits: How Cancer Screening is Portrayed in the UK National Press. Jack W Bedeman, Susanne F Meisel, Nora Pashayan.

http://annals.org/article.aspx?articleid=2518279

Ann Intern Med. 2016;164(9):W13-W14. doi:10.7326/G15-0019

Posted in Breast Cancer, breast screening, Campaigns, cancer, citizen safety, Compassion in healthcare, harms, healthcare modernisation, information, informed consent, mastectomy, medicine's flaws, openness, overdiagnosis, overtreatment, patient safety, personal autonomy, prostate cancer, Screening, Screening Mammography, screening prostate cancer, Uncategorized | Tagged , , , , , , , , , , , , , , , , | Leave a comment