Breast screening – lack of effectiveness

A new study published in the Journal of the Royal Society of Medicine, and reported in the media today, has shown there is no evidence of an effect of mammographic screening on population-level breast cancer mortality: ‘Breast cancer mortality trends in England and the assessment of the effectiveness of mammography screening: population-based study’. Toqir K Mukhtar, David RG Yeates, Michael J Goldacre:
http://jrs.sagepub.com/content/106/6/234

The online version of this article can be found at:
DOI: 10.1177/0141076813486779
J R Soc Med 2013 106: 234

There are the usual responses in newspapers, eg The Telegraph, from women who claim their lives have been ‘saved’ by screening, but sadly they cannot know this. They know that mammography found ‘something’ that was treated. Was it a true cancer or a ‘pseudo-cancer’? Would it have progressed if no treatment had been given, or never been a problem during their lifetime? Has finding it ‘early’ made any difference to their prognosis? Isn’t it the less aggressive cancers that tend to be found by mammography screening anyway, the ones likely to kill being faster growing, so tending to pop up between screenings?

What is sad, but understandable, is that women have come to rely on breast screening as a life-saver, because NHS BSP information has impressed this upon them as a truth, and even quoted numbers of lives saved per annum.

‘What will we do without screening – what can we have instead?’ they ask.
Without breast screening they will not risk becoming a cancer patient unnecessarily, being treated unnecessarily, and suffering side effects (including radiation-induced cancer and death) from treatments. Without it they can lead a normal life as a breast-aware non-breast cancer patient. I suppose if you have faith in your ability to win the lottery, so don’t mind the 3 to 1 chance of harm rather than benefit (ie for the sake of a potential benefit to someone, somewhere, maybe, in the screened population, and unlikely, statistically to be you) then you might want to be screened. But that figure did not take into account deaths from treatments, which have been shown to be still significant (ischemic heat disease, possibly cardiomyopathy,). And for another cause of death for women over-diagnosed and over-treated for breast cancer – see:
http://www.thebreastonline.com/article/PIIS0960977613000994/abstract?rss=yes

Breast cancer treatments can also cause womb cancer, radiation-induced bone loss, lung fibrosis, lung cancer, breast cancer and lymphoedema.

See also:
http://theconversation.com/breast-cancer-screening-needs-to-make-more-than-economic-sense-14229

And in another article, top breast surgeon Professor Michael Baum raises significant doubts about the Marmot Report – British Journal of Cancer
http://www.nature.com/bjc/journal/vaop/ncurrent/full/bjc2013258a.html

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About bmitzi

Medical writer, author, artist. Cancer campaigner. Aiming always to improve health services and bring compassion into health care.
This entry was posted in Breast Cancer, Campaigns, Compassion in healthcare, patient safety, Screening, Screening Mammography, Womb cancer and hysterectomy and tagged , , , , . Bookmark the permalink.

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