In a ‘patient perspective’, ‘Breast cancer screening: an ethical dilemma or an opportunity for openness?’ published in the April edition of Quality in Primary Care, I consider the evidence showing lack of effectiveness and major harms of the NHS Breast Screening Programme and question the ethics of running an Age Extension Randomised Controlled Trial at all, let alone before an Independent Review of the programme had concluded. I wonder why, when those who attend mammographic screening are three times as likely to be ‘over-diagnosed’ (and over-treated) as to benefit (Marmot Report – and even this benefit is disputed), women continue to receive an unsolicited appointment which seems to endorse screening as beneficial. As for consent: ‘Professor Sir Mike Richards said the decision to be screened should be a woman’s choice – but he also said screening was still recommended.’
I also question the GP role, sign-posted as a source of further information, when GPs may be paid to encourage women to participate in breast screening (as well as other interventions) as part of ‘local enhanced services payments’ (confirmed by the Department of Health in a telephone conversation 26 November 2012). ‘Are they content to be placed in a position which undermines trust and could break the doctor/patient relationship?’ And how about those involved in the screening programme/industry – they did not train in order to cause harm.
Blennerhassett M. Breast cancer screening: an ethical dilemma, or an opportunity for openness? Quality in Primary Care.2013; 21:39-42.