Screening harms: why change is needed

Significant article on PSA screening echoes repeated findings on breast screening mammography, ie plenty of harms, but little effect on mortality.

Just as with breast screening, prostate cancer screening is controversial: ‘…potential mortality or quality-of-life benefits may be outweighed by harms from overdetection and overtreatment’.

The findings of this trial showed the effect of psa screening on prostate cancer mortality echoed similar conclusions from years of breast screening research on breast cancer mortality: ‘The single PSA screening intervention detected more prostate cancer cases but had no significant effect on prostate cancer mortality after a median follow-up of 10 years.’

‘The findings do not support single PSA testing for population-based screening’.

Are the potential harms of screening adequately explained to people invited to participate?

Effect of Low-intensity PSA-Based Screening Intervention on Prostate Cancer Mortality. The CAP Randomized Clinical Trial.

Richard M Martin, Jenny L Donovan, Emma L Turner et al. JAMA. 2018;319(9):883-895

Posted in Breast Cancer, breast screening, Campaigns, citizen safety, Compassion in healthcare, diagnoses, dying, harms, healthcare modernisation, information, informed consent, medicine's flaws, Over-medicalisation, overdiagnosis, overtreatment, prostate cancer, Public safety, Screening, Screening Mammography, screening prostate cancer | Tagged , , , , | Leave a comment

Breast screening, cancer treatments and cardiovascular disease

This article highlights serious risks to cardiovascular health caused by breast cancer treatments (which need to be considered as part of overdiagnosis and overtreatment due to breast screening mammography).

‘…current breast cancer treatments can have a negative impact on cardiovascular health (eg, left ventricular dysfunction, accelerated CVD) …’ ‘For older women, CVD poses a greater mortality threat than breast cancer itself.’

‘Cardiovascular disease and breast cancer: where these entities intersect: a scientific statement from the American Heart Association’. Laxmi S Mehta et al. Circulation, February 6, 2018. Vol 137, Issue 6.

Posted in Breast Cancer, breast screening, Campaigns, cancer, citizen safety, Compassion in healthcare, healthcare modernisation, informed consent, medicine's flaws, Over-medicalisation, overdiagnosis, overtreatment, personal autonomy, Public safety, Screening, Screening Mammography | Tagged , , , , | Leave a comment

Assisted Dying – BMJ articles & poll

The BMJ has published a series of articles on assisted dying, including an editorial urging a poll of UK doctors. Dr Jacky Davis sets out how the BMA’s current position is unrepresentative and in the patient commentary Sarah Jessiman explained why she wants the choice of an assisted death.

The bmj list of articles on assisted dying can be found at:

This week’s bmj poll ‘Should doctor assisted-dying be legal?’ can be found at:

scroll down for poll, centre page, where you can also find link to

Editor’s Choice – Assisted dying – it’s time to poll UK doctors:


Personal View – ‘Most UK doctors support assisted dying, a new poll shows: the BMA’s opposition does not represent members’

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Doctors’ hidden conflicts of interest

‘Here’s a game: try to find a doctor’s conflicts of interest. Set a timer, and give yourself the freedom of the internet… ‘

‘ The Association of the British Pharmaceutical Industry voluntarily publishes payments made by the drug industry to doctors.1 But at least half of those payments—£53m (€60.1m; $73.7m) in total—aren’t declared.2 And drug company payments aren’t the only conflict a doctor can have …’

Margaret McCartney: Hiding and seeking doctors’ conflicts of interest.

BMJ 2018;360:k135

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Cancer and living

“What to say when you meet the angel of death at a party – after years of living with stage IV cancer, I have some suggestions” – great article by Kate Bowler, The New York Times, 26 January 2018.

So many people will relate to this. I well remember the ‘weren’t you lucky’ and ‘I thought you were dead’ comments in the wake of aggressive treatments and lack of pain relief that left me banging my head on the wall and seeing suicide as the only way to gain relief.

The poems that poured out at 3am night after night eventually became the backbone of a book: ‘Nothing Personal, disturbing undercurrents in cancer care’ (Radcliffe Publishing) – reads like a novel, but also has discussion sections which look at the many issues and what needed to change. Supported by links to research findings for better/evidence-based practice, it’s also useful for medical education. (Winner, Medical Journalists’ Association Open Book Award 2009 – and just as fulfilling, the many ‘I couldn’t put it down’ comments, including those of the MJA judges.)

Posted in anal cancer, Campaigns, cancer, clinical trials, Compassion in healthcare, healthcare modernisation, information, informed consent, patient/doctor communication, personal autonomy, rarer and uncommon cancers, speaking out | Tagged , , , , | Leave a comment

‘Flu vaccines

Public Health England has warned that the trivalent flu vaccine, most commonly administered in general practice, won’t protect against the influenza B strain predominantly circulating.

Jacqui Wise, BMJ, 5 January 2018.

BMJ 2018;360:k78

(Some vaccines cost more than others.  Do you know which was on offer for you?)

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Breast screening: effectiveness (or otherwise) and harm

This BMJ article concludes that the Dutch mammography screening programme appears to have little impact on the number of advanced breast cancers – a marginal effect on breast cancer mortality – and half the screen detected cancers represent overdiagnosis (which brings great risk of overtreatment etc).

Year on year robust research proves the ineffectiveness and harms of breast screening, but until women, the public, and influential breast cancer organisations understand why the programme still does not save the vast numbers of lives as claimed, it’s likely that successive governments will continue to pour millions of pounds into it – or risk losing votes – money that could be so much better used in breast cancer services. And despite years of proven evidence against breast cancer screening, the AgeUK research trial (‘the largest RCT in the world’ according to the then Cancer Czar) continues to be used to recruit greater and greater numbers of women for screening. How many of them realise what they are consenting to?

Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study. Philippe Autier, Magali Boniol, Alice Koechlin, Cécile Pizot, Mathieu Boniol.

BMJ 2017;359:j5224

Posted in Breast Cancer, breast screening, Campaigns, harms, healthcare modernisation, Over-medicalisation, overdiagnosis, overtreatment, Public safety, Screening, Screening Mammography | Tagged , , | Leave a comment