The call for full information and fully informed consent in breast screening has been ignored for years. In 2010 a revised, more informative breast screening leaflet was issued (covered in pretty flowers – some might see as contributing to subtle reassurance/coercion? – just as our local breast screening centre is named ‘the Magnolia Centre’) but it still did not say enough or give the scale of risks or harms women need to know in order to make an informed choice. More and more research emerged and then the ‘independent’ review was announced.
This week’s bmj has some of the responses to that announcement which include calls for the review to be undertaken by NICE (National Institute of Health and Clinical Excellence) because those currently leading the review have stated their support for breast screening and anyone who has published on the subject will be barred from contributing to the review.
In Editor’s Choice, Mammography Wars (BMJ 2011; 343 doi: 10.1136/bmj.d7623 (Published 23 November 2011) Cite this as: BMJ 2011;343:bmj.d7623 ) Fiona Godlee says the recommendations in the Canadian taskforce’s recently published revised guidelines on breast cancer screening (doi:10.1136/bmj.d7625) mirror those from the US Preventive Services Taskforce: ‘in women who aren’t at high risk, don’t start routine mammography until age 50, screen only every two to three years, and stop routine clinical breast examination.’ But the Canadian guidelines are already under fire, as were US guidelines published in 2009, so will new UK guidelines meet the same fierce opposition? She adds: ‘The fact that both of these national task forces have reached the same conclusion should give some confidence in the result, but there is no doubting the heat in this controversy.’
In the same journal, Adrian O’Dowd also comments on the Canadian guidelines: ‘Women in their 40s should not be screened for breast cancer’, new Canadian guideline says
BMJ 2011; 343 doi: 10.1136/bmj.d7625 (Published 23 November 2011)
Cite this as: BMJ 2011;343:bmj.d7625
Perhaps the first thing lay people need to understand is the difference between screening mammography (a programme of regular mammography for apparently healthy women) and diagnostic mammography (investigating symptoms) – and apologies if that seems patronising to those who already understand, but the two are often confused.
Then it would help if they could do critical analysis and understand the language of research! But the nub of the message coming out is that blanket screening causes much harm and it should be targeted to those most at risk. A triage system is needed: Those at highest risk first need genetic counselling/testing; those at lowest risk need screening for risk factors for cardio-vascular disease/life-style advice etc; the intermediate group might have the most favourable benefit/harm ratio from mammographic screening. According to Professor Michael Baum, RARM (Risk assessment/risk management) is needed. The details of his suggestions can be found in: Baum M. Science in Parliament (SIP) Vol 66, Autumn 2009. © Mitzi Blennerhassett 2011