Breast cancer screening – short video explains reality

TIME FOR HONESTY – This short video presents the true picture of breast screening programmes in a very easy to understand format. How shocking that this harmful ‘industry’ is allowed to continue (NHS BSP) and the age limit extended at both ends (due to massive charity pressures on parliament) – and the extension used as ‘the biggest randomissed controlled trial in the world’. How many women realise that – or what they are voluntarily subjecting their bodies to…all without full information or written consent? With GPs being paid to encourage women to attend breast screening…Sisters – spread the word if you value your breasts: Click on the gear wheel below the video for optional language subtitles: (or here’s the direct english link: https://www.youtube.com/watch?v=WokeeihfCnw)

Diagnostic shades of grey

How many patients (and doctors) are unaware of the range of variability in diagnoses that can derive from the same pathology sample? How much accepted ‘certainty’ is, in fact, ‘uncertain’? Read on, and you may never want to accept a diagnosis without getting a second opinion – or a third.

When Diagnostic Uncertainty Hits Home. Joann Elmore. BMJ Opinion, 28 June 2017.

http://blogs.bmj.com/bmj/2017/06/28/joann-elmore-when-diagnostic-uncertainty-hits-home/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+bmj%2Fblogs+%28Latest+BMJ+blogs%29&g=w_bmj-com

The article includes some useful links eg http://www.nejm.org/doi/full/10.1056/NEJM199412013312206

‘Variability in Radiologists’ Interpretations of Mammograms. Joann G. Elmore, Carolyn K. Wells, Carol H. Lee, Debra H. Howard, and Alvan R. Feinstein

N Engl J Med 1994; 331:1493-1499 December 1, 1994 – which calls for efforts to improve accuracy and reduce variability in interpretations of mammography.

GP Payments

In my rapid response to this BMJ article I should have mentioned GP payments that were given for not referring patients. Does anyone else have the sense that there are also cut-off points for referral, diagnostic investigations or treatments at say age 75? Or above? That’s certainly the impression I’m getting from friends and colleagues.

Prescribing incentives feel grubby because they are. Margaret McCartney. BMJ 2017;357:j2695

http://www.bmj.com/content/357/bmj.j2695?

Are wealthier people at extra risk of harm?

In this New England Journal of Medicine paper, Welch and colleagues discuss whether wealthier people receive too much care – ie more than is good for them. “Excessive testing of low-risk people produces real harm, leading to treatments that have no benefit (because there is nothing to fix) but can nonetheless result in medication side effects, surgical complications, and occasionally even death.’

Income and Cancer Overdiagnosis – When Too Much Care is Harmful. H Gilbert Welch, Elliott S Fisher. N Engl J Med 376;23, 2208-2209. June 8 2017. http://www.nejm.org/doi/pdf/10.1056/NEJMp1615069

 

Breast cancer screening – DCIS and the COMET trial

Women diagnosed with Ductal Carcinoma in Situ (DCIS) are usually offered lumpectomy or mastectomy as standard treatment, although DCIS is not usually recognised as an actual cancer, but rather cell changes which may or may not become cancerous in the future. In an attempt to combat overtreatment of women diagnosed with DCIS, the prospective, randomised clinical trial, COMET, (Comparison of Operative to Medical Endcrine Therapy) will test whether or not active surveillance (as offered in prostate cancer) with close monitoring would be a safe option.

Laurie McGinley. Waiting and watching with ‘Stage O’ cancer put to nationwide test.

https://www.washingtonpost.com/national/health-science/waiting-and-watching-with-stage-0-breast-cancer-put-to-nationwide-test/2017/04/29/60e47bde-1f8f-11e7-ad74-3a742a6e93a7_story.html?utm_term=.682cd66f5e6e

Breast cancer screening – why do physicians continue to ignore national guidelines?’

When research shows breast cancer screening participants are more likely to experience more harms than benefits, why do physicians continue to ignore national guidelines and recommend screening mammography?

“There have been many explanations over the years for why physicians perform tests and procedures for which there is no evidence of benefit – or, in this case, where there is actual evidence of harm.’

Physician Adherence to Breast Cancer Screening Recommendations

Deborah Grady, Rita F. Redberg.

http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2617273

Insights from a doctor’s experience as a patient

A recent feature in the Medical Defence Union Journal offers insight into the doctor-patient relationship from a doctor-patient.

‘The overwhelming realisation was that despite being highly qualified, intelligent and driven professionals, we often forget the simple things. The fact that I am here and able to write this is testament to the good care that I received. However, the truth is that it’s the difficult, painful moments and words that are the ones that I and, I suspect, other patients remember forever, and which have a lasting effect on us’ writes Dr Nia Wyn Davies… ‘Patients respect honesty from their doctors. Where there is no hope we owe it to them to tell them so, tactfully and gently. But whilst there is light, however dim, at the end of the tunnel, we must reassure our patients and their relatives of this and allow them to hope, whilst we manage the reality.’

Since she is a doctor, it is doubly shocking that her concerns were dismissed. The need for compassion in healthcare is just one of the lessons highlighted by this article.

N W Davies. The receiving end – a doctor’s insight. Medical Defence Union Journal.

https://mdujournal.themdu.com/issue-archive/spring-2017/the-receiving-end—a-doctors-insight?utm_source=MDU%20Services%20Ltd&utm_medium=email&utm_campaign=8036468_%231574%20-%20MDU%20journal%20issue%207%20email%201&utm_content=insight&dm_i=PBJ,4S8Z8,4HM4AQ,I7YB4,1