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