So there is to be a review of the NHS Breast Screening Programme.
Here’s the link for Susan Bewley’s letter – which prompted the reply from Mike Richards and the announcement of an ‘independent’ review (link also shown here).
Women who would really like to know the truth about breast screening might like to scroll down to ‘rapid responses’, as well as related articles. As you will see, there is uncertainty about how ‘independent’ such a review will be, given that all those who have already expressed an opinion (ie concerned experts) will be excluded from the review panel. There is a call for NICE to conduct the review.
My own response concentrates on Prof Mike Richard’s words that the extended breast screening programme will be the largest randomized controlled trial (RCT) in the world – yet the invitation I received did not mention that it was an RCT – let alone the largest in the world. This throws up issues of consent – and once again issues of inadequate information affecting patient choice. Openness is now imperative because screening has been shown to cause as much harm as benefit.
There are not only false positives and false negatives, which have an impact on treatment, but ‘over-diagnoses’ – tiny changes shown by improved screening may never progress to cancer, yet women are treated and become cancer patients. Even if the ‘pseudo-cancers’ do progress into full-blown cancer, the woman becomes a cancer patient (with all this means for insurance, stress, pain, lifelong risk of lymphoedema etc) earlier than she would have done – unnecessarily early, because finding breast cancer when ‘small’ does not necessarily equate to saving lives. (Please scroll down to responses and other articles by experts if you want to understand this complex issue – and perhaps take a look at the different approach to screening for prostate cancer).
This review does not stem from an NHS commitment to save money (although the money saved from a more personalised approach could be used to improve breast cancer services) rather it comes from eminent surgeons, researchers, epidemiologists and others who have demonstrated the present inadequacies and harms of the breast screening programme as it stands and voiced concerns – for the sake of screened women – because of the scale of these harms.
Professor Michael Baum suggests replacing the present programme with a triage system based on risk assessment/risk management (for some – who can be identified – the risk of harm from screening would be outweighed by the risk of getting breast cancer – so it would make sense for them to be screened regularly, but only after being given full information).
It is important to differentiate between screening mammography – used regularly as part of the NHS Breast Screening Programme – and mammography used when people have symptoms which need further investigation. Mammography can be a useful tool – it is the blanket screening of healthy women with resultant unnecessary harms that is under review.