Breast screening review

Back from NCRI conference, Liverpool. My poster had been about the need for a review of the breast screening programme, but a few days before the conference the Cancer Czar, Mike Richards, announced there was to be an ‘independent review’ of the NHS BSP (see bmj link below). So my presentation was amended to look at why a review is needed but questioning how it can be independent when the two people leading it, Mike Richards and Harpal Kumar, have already expressed their views, while all others who have published on the subject will be barred from contributing to the review (see MR letter in bmj – link below).

Similar concerns are expressed in several of the responses to the letter.
The following links may be of interest.

Further references – screening mammography poster NCRI conference, November 2011.
*COCHRANE LEAFLET: screening for breast cancer with mammography
Breast cancer screening is to be reviewed, cancer tsar announces. Nigel Hawkes BMJ 2011;343:doi:10.1136/bmj.d6905 (Published 26 October 2011)
An independent review is under way. Richards M. BMJ 2011; 343:d6843 doi: 10.1136/bmj.d6843 (Published 25 October 2011)
Does breast screening do more harm than good? A new UK review of the benefits & harms of screening is welcome, but what we really need is better evidence. M. Baum 3 November 2011.

To suggest a topic for NICE (eg breast screening):
Considering when it might be best not to know about cancer. Gina Kolata. News Analyses. The New York Times National, Sunday 30 October 2011.
– M Baum’s UCL Lunchtime Lecture. ‘Breast screening: some inconvenient truths’ 28 October 2010. Accessed 4 November 2011.

Science in Parliament. Baum M.Vol 66 No 4. Autumn 2009. The Journal of the Parliamentary and Scientific Committee, p 12-13.

Likelihood that a woman with screen-detected breast cancer has had her ‘life saved’ by that screening. H. Gilbert Welch, MD, MPH; Brittney A. Frankel
Arch Intern Med. Published online October 24, 2011. doi:10.1001/archinternmed.2011.476
Who evaluates public health programmes? A review of the NHS Breast Screening Programme. Jorgensen KJ, Gotzsche PC. JR Soc Med 2010;102:14-20.
An economic evaluation of the war on cancer. Goldman D, Jena AB, Lakdawalla D, Philipson T, Reyes C, Sun E.VOX 11 January 2010. concluded 90% of mortality reduction CAB in last decades due to treatment improvements NOT early detection.
The Natural History of Invasive Breast Cancers Detected by Screening Mammography. Per-Hendrik Zahl, MD, PhD et al Arch Intern Med. 2008;168(21):2311-2316.
The Art of Medicine, Decision-Making and Fear in the midst of Life. Aronowitz R. Vol 375 April 24, 2010.
Systematic review of screening for breast cancer with mammography. Olsen O, Gotzsche PC. The Nordic Cochrane Centre. Published October 20, 2001.
Screening for Breast Cancer with Mammography (Review). Gotzsche PC, Nielsen M. The Cochrane Library 2009, Issue 4.
Screening for breast cancer – balancing the debate. Klim McPherson.
BMJ 2010; 340:c3106
‘Well, have I got cancer or haven’t I?’ The psycho-social issues for women diagnosed with ductal carcinoma in situ. De Morgan S, Redman S, White KJ, Cakir B, Boyages J. Health Expectations. 5: Dec 2002:310-318.
Women need better information about routine mammography. Thornton H, Edwards A, Baum M. BMJ 2003; 327:101-3.
Women’s information needs about ductal carcinoma in situ before mammographic screening and after diagnosis: a qualitative study. Prinjha S, Evans J, Mcpherson A. J Med Screen 2006; 13:110-114.
‘A Mastectomy for something that wasn’t even truly invasive cancer’. Women’s understandings of having a mastectomy for screen-detected DCIS: a qualitative study S Prinjha S, Evans J, Ziebland S, McPherson A. J Med Screen 2011; 18:34-40.
Treatment of ductal carcinoma in situ Julia A Smith. BMJ 2011;343:d5344 19 September 2011. and response by Miriam Pryke 9 October 2011
Time for a Screen Break? Large-scale medical screening is meant to save lives, but critics say that it only causes needless suffering. John Naish, The Times Newspaper 6 September 2011, Section 2:
It is not wrong to say no. Iona Heath, general practitioner, London. BMJ 2009;338:b2529
Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database. Autier P, Boniol M, Gavin A, Vatten LJ. BMJ 2011; 343:d4411.
Breast cancer mortality in organised mammography screening in Denmark. A comparative study. BMJ 2010;340:c1241. Jorgensen KJ, Zahl PH, Gotzsche PC.
Effect of Screening mammography on Breast Cancer Mortality in Norway. Kalager M, Zelen M, Lanmark MD, Adam H-O. N Engl J Med 2010;363:1203-10.
Effects of mammography screening on surgical treatment for breast cancer in Norway. Suhrke P, Maehlen J, Schlichting E, Jorgensen KJ, Gotzsche P C, Zahl P-H. BMJ 2011; 343:d4692 7 July 2011 (accessed 9 October 2011)
An Investigation of the Apparent Breast Cancer Epidemic in France: screening and incidence trends in birth cohorts. Junod B, Zahl P-H, Kaplan R M, Olsen J, Greenland S. BMC Cancer 2011, 11:401
Breast cancer incidence and over-diagnosis in Catalonia (Spain)’. Martinez-Alonso et al. Breast Cancer Research 2010.12R58.
Breast cancer screening. Table 1: Harms of screening mammography. Questions about cancer. National Cancer Institute at the National Institutes of Health. (accessed 9 October 2011)
US breast cancer mortality is consistent with European data. Bleyer A. bmj 2011/343:d5630
The Breast screening programme and misinforming the public. Gotzsche Peter C, Jorgensen KJ. JR Soc J R Soc Med September 2011 vol. 104 no. 9 361-369
Breast screening: the facts – or maybe not. Peter Gotzsche et al. BMJ 2009; 338:b86
Still awaiting screening facts. M Baum, Hazel Thornton, Peter Gotzsche. 2 November 2010.
Disparities in breast cancer mortality trends between 30 European countries: retrospective trend analysis of WHO mortality database. Autier P, Boniol M, LaVecchia C, et al. BMJ 2010;341:3620
Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database. Autier P et al. BMJ 2011; 343:d4411
Prone to Error; earliest steps to find cancer. Stephanie Saul. New York Times:
Goldman D, Jena AB, Lakdawalla D, Philipson T, Reyes C, Sun E. An economic evaluation of the war on cancer. 11 January 2010.
Should we use total mortality rather than cancer specific mortality to judge cancer screening programmes? No. Steele R JC, Brewster DH. BMJ 2011; 343:d6397 doi: 10.1136/bmj.d6397 (Published 13 October 2011)
Should we use total mortality rather than cancer specific mortality to judge cancer screening programmes? Yes. Penston, J. BMJ 2011; 343:d6395
Response: Cancer specific mortality is biased in breast screening trials – Peter C Gotzsche, Director, Nordic Cochrane Centre

Information about screening: is it to achieve high uptake or to ensure informed choice? Angela E. Raffle FFPHM Consultant in Public Health Medicine, Avon Health Authority, King Square House, Bristol, UK
Health Expectations Volume 4, Issue 2, Article first published online: 20 DEC 2001

Margaret McCartney’s blog
Call for a judicial review of the breast screening programme and for an independent body of people to write the information offered to women. (The Sunday Times, 31 July 2011, M Baum et al)
Let’s get frank about breast screening. Cornelia Baines
Breast Screening Controversy. M Baum, Letters pager, The Times Newspaper, 2 September 2011.
Breast screening should be scrapped. Evidence points to the fact that cancer mortality rates are dropping due to improved treatment, not mammograms. Professor M Baum. The Guardian Newspaper

No more mammograms for me By Veneta Masson
Special to The Washington Post, Tuesday, October 12, 2010; E1
In full
‘No Mammo?’ – Rachel Campergue, preface Dr Bernard Junod. Published 29 September 2011 – Max Milo. (French)
Books, booklets, leaflets
Cochrane leaflet: Screening for breast cancer with mammography

Breast beating. A personal odyssey in the quest for an understanding of breast cancer the meaning of life and other easy questions` M Baum. Anshan, 2010.

Testing treatments: better research for better healthcare. (Imogen Evans, Hazel Thornton, Iain Chalmers) – reprint by Pinter and Martin 2010 – or download it from the James Lind Library website (

Should I be tested for cancer? Maybe not and here’s why. H Gilbert Welch University of California Press, 2004. ISBN 0520239768
‘Smart Health Choices – making sense of health advice’, by Irwig, Irwig, Trevena and Sweet – freely accessible online – to read or to download. PDFs are available for downloading under each section:
*COCHRANE LEAFLET: screening for breast cancer with mammography
Health Knowledge website – Over-detection in breast screening is in chapter 2, Thornton, M Baum et al, letter, The Times Newspaper, 19 February 2009
‘Making Sense of Screening’ freely downloadable booklet.
NHS breast screening. NHS Cancer Screening Programmes. Department of Health in association with NHS Cancer Screening Programmes. 2010. (Tel 0300 123 1002 quote: 403722/Breast Screening.) (accessed 9 October 2011).

Mitzi Blennerhassett


About bmitzi

Medical writer, author, artist. Cancer campaigner. Aiming always to improve health services and bring compassion into health care.
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