Breast Screening: The need for better public information

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Breast Screening – BMJ article discusses limitations of polygenic scores

This week’s BMJ contains a paper by Amit Sud et al entitled
‘Realistic expectations are key to realising the benefits of polygenic scores’. It includes what could be an extremely useful, easily understood decision tool for anyone considering being screened.

https://www.bmj.com/content/380/bmj-2022-073149

Although enthusiasm has greeted government reports on polygenic scores (the Genome UK report describing them as offering a “step change” in screening for disease) these have their limitations.

NHS risk information based on polygenic scores is set to inform clinical decision-making, including access to screening, and will be offered to five million people as part of the research programe, ‘Our Future Health’. However, this BMJ paper warns ‘…we should recognise that these scores are limited in their potential to predict disease. If we do not set our expectations accordingly, they could harm rather than help.
Polygenic scores will always be limited in their ability to predict disease’.

BMJ 2023;380:e073149

From Covid to the energy crisis – superb article from Kamran Abbasi, BMJ Editor’s Choice, 4 September 2022

‘After covid, politicians are failing us again over the energy crisis’ –

and

‘It may be worth remembering how August 2022 feels, because a politician or a commentator may tell you in a year or two that the NHS and energy crises were figments of our imaginations, that the public or experts panicked and foisted disastrous policies on politicians’ …so writes Kamran Abbasi with links to many articles around the issues, including children and schools.

A must-read for anyone interested in the truth about covid, ‘following the science’, government policy/ the public enquiry, and, similarly, the energy crisis.

https://emails.bmj.com/q/11oNf2DhwGmpsk48Lnezhrf/wv

breast screening – bmj podcast on overdiagnosis

I just came across this bmj podcast for medical students and doctors – highlights subjects not taught in medical school:

https://www.google.com/search?client=firefox-b-d&q=bmj+shapscratch

or https://www.bmj.com/sharpscratch

It’s a podcast for med students and docs – the red one with pic of sticking plaster is about overdiagnosis.

Breast cancer screening: important new research information for women and policy makers

Breast cancer screening: important new research information for women and policy makers

The ‘Effects of awareness of breast cancer overdiagnosis among women with screen-detected or incidentally found breast cancer: a qualitative interview study – explores the awareness of women who identified themselves as having a possible breast cancer overdiagnosis’.

This is a particularly important study because women need to be properly informed of the risks of overdiagnosis and overtreatment before they choose to accept or decline a breast cancer screening invitation. The study provides rare insight into the ‘profound negative impact of finding out about overdiagnosis after a diagnosis of breast cancer’.

Study participants’ own ‘Suggestions for Other Women’ are summarised in a linked supplemental online file.

Implications for clinicians and policy makers

 ‘…it is important that policymakers and clinicians improve current practice by considering these findings and suggestions made by our study participants. There is a need to adequately inform women considering breast screening of the risks of overdiagnosis and overtreatment.’

Pickles K, Hersch J, Nickel B, et al

Effects of awareness of breast cancer overdiagnosis among women with screen-detected or incidentally found breast cancer: a qualitative interview study

BMJ Open 2022;12:e061211. doi: 10.1136/bmjopen-2022-061211

https://bmjopen.bmj.com/content/12/6/e061211

Breast cancer screening aid

Informing Women About Overdetection in Breast Cancer Screening:
Two-Year Outcomes From a Randomized Trial
Jolyn Hersch , Alexandra Barratt, Kevin McGeechan, Jesse Jansen et al.
JNCI Natl Cancer Inst (2021) 113(11): djab083 First published April 19, 2021.

Brief decision aid brings lasting improvement to women’s understanding of potential consequences of breast cancer screening without changing participation rates.

‘Abstract
Background: Supporting well-informed decisions about breast cancer screening requires communicating that inconsequential disease may be detected, leading to overdiagnosis and overtreatment. Having previously shown that telling women about overdetection improved informed choice, we investigated effects on screening knowledge and participation over 2 years.’

‘Conclusions: A brief decision aid produced lasting improvement in women’s understanding of potential consequences of screening, including overdetection, without changing participation rates. These findings support the use of decision aids for breast cancer screening.’

The updated Intervention Decision Aid is freely available online: https://ses.library.usyd.edu.au/bitstream/handle/2123/16658/2017%20updated%20breast%20screening%20DA%20%28Hersch%20et%20al%29.pdf?sequence=1&isAllowed=y

NEJM widens public access via new partnership

The New England Journal of Medicine is broadening public access to high quality information by sharing short video summaries through their channel on You Tube which will include summaries of article findings and their implications using interviews, animations and more.

How the New England Journal of Medicine is broadening access to high-quality health information

Breast cancer screening – financial incentives

An informative BMJ article by Dr Theodore Bartholomew and colleagues this week discusses the pros and cons of breast cancer screening (the latter includes overdiagnosis) together with potential consequences of financial incentives:

Financial Incentives for Breast Cancer Screening undermine informed choice. BMJ 2022;376:e065726

https://www.bmj.com/content/376/bmj-2021-065726

They argue that the focus should be on decision making not uptake when the balance of benefit and harm is subjective. The article includes a useful icon array from the Harding Centre for Risk Literacy as an example of a breast cancer screening decision aid. (- If only women invited to breast cancer screening were offered this decision aid their understanding re screening would be enhanced, their decision better informed.)

Inadvertent Patient Harm: doctors, managers, medical education, patients, public, policy makers

Patients’ Emancipation: Towards Equality. Charlotte Williamson. Please see flyer, review etc two pages back. Details and review also on Amazon. Clear, well-structured information and suggestions for healthcare modernisation to benefit providers and patients.

Overdiagnosis and climate change

“Tackling overdiagnosis takes on a new urgency in the context of climate change.

At the extreme end of low value care is no value care—otherwise known as overdiagnosis. Overdiagnosis is the detection of harmless conditions that could be safely left undiagnosed and untreated.23 Once diagnosed, however, a cascade of tests and treatment usually follows, which will not benefit patients who were not unwell to start with…”

Overdiagnosis is increasing the carbon footprint of healthcare. Alexandra Barratt, professor of public health, Forbes McGain, associate professor. https://doi.org/10.1136/bmj.n2407 (Published 04 October 2021).

BMJ 2021;375:n2407