Overdiagnosis, breast screening and the Montgomery ruling

Overdiagnosis

The latest musical parody from the endlessly creative James McCormack:

and

The Emperor’s New Clothes, or ‘Breast Screening Unzipped’:

Screening! We love screening!
It not only saves our lives – it saves breasts too!
Screening! Lovely screening!
– If they take away our screening, what’re we going to do?

Hallo! I’m the Messenger
Shoot me if you must
But isn’t ‘having eyes opened’
better than ‘blind trust’?

So – ‘what did they say to those ladies?’
asked to come in for the test
And why did those ladies believe them?’ –
Was it fear of losing a breast?
Why comply
Stand in line – and comply?

‘Screening Saves Lives’, pledged the mantra
The same message over the years
And ‘finding it early’s the best thing’
If you want to allay all your fears
– Must be true
It’s the best thing to do

That’s why we ladies believed them
We didn’t want to be dead!
And words that are often repeated (‘Saves Lives’!)
Tend to stick inside your head
In your head
-Become truth…in your head

We never knew of the dangers
Or that where ‘take-up’ was low
GPs were paid to encourage us
Yes, pressure us ladies to go!
Yes, comply
– despite harms, just comply

Unsolicited appointments drop through the door
pointing out the carrot – ‘screening is for free’
but the cost of acceptance is not monetary
decline the invitation and expect to get more-
‘your doctor is concerned that you didn’t attend’
– we were ‘ignorant’ and ‘stupid’
to decline, the tone implied
– so we doubted ourselves
and, in the end – we went

Had the mantra lied?
For, despite the great cost in ladies’ lives lost
Screening failed to produce
– And advanced breast cancer deaths
simply failed to reduce!

Such inconvenient truths!

Yes, it’s counter-intuitive
But the Marmot Review
looked at all the evidence
And the Parliamentary Inquiry
made the same conclusions too:
Screening harms many
and benefits few

False-positives and negatives
plus radiation risks
And overdiagnosis, such as DCIS
So-called ‘cancers’ that may not ever progress
Yet ‘treatment of choice’ is likely to be
mastectomy

But without sufficient take-up
the Juggernaut would fail
Think of the outcry!
Think of votes lost…
Protect the screening industry
jobs, and machinery
(at any cost)
Stick to the ‘no-brainer’ everybody knew:
‘finding it early is the best thing you can do!’

‘Don’t take away our screening’ cried the ladies who had ‘been there’
‘Screening works – you can see!
‘Saved our lives – just- look- at- me!

Well-meaning patient advocates descended on London
Their serried ranks filling Westminster halls
Echoing mis-guided cancer charities’ calls to
‘Extend the screening age range!’

So, screening was extended –
But now participation meant automatic entry to an R.C.T.
A Randomised Controlled Trial
‘the largest in the world’ they said
But still they didn’t tell us – how could this be?

A human experiment – with only implied consent, based on false information?
Just how ethical was this R.C.T. ?

Has oversight been lacking?
What’s the full story?
I tried to get some answers – wrote to all and sundry
But they weren’t giving explanations to the likes of me

Then along came HealthWatch, the independent charity
For science and integrity
They didn’t find it easy, but they got the story out
With research links posted for everyone to see

Though it goes against all we’ve been told in the past
The ‘find it early ‘ principle has been unmasked

Yes, it’s counter-intuitive but
unlikely as it seems –
A breast cancer diagnosis is more likely if you’re screened

Mitzi Blennerhassett (c) 2015

http://www.healthwatch-uk.org

‘New rules of consent – the patient decides’. The Montgomery ruling and breast cancer screening – Alain Braillon, Susan Bewley: http://www.bmj.com/content/350/bmj.h1534/rapid-responses

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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, breast screening, Campaigns, clinical trials, Compassion in healthcare, healthcare modernisation, Over-medicalisation, patient/doctor communication, Public safety, Screening, Screening Mammography and tagged , , , , , , , , , , , . Bookmark the permalink.

6 Responses to Overdiagnosis, breast screening and the Montgomery ruling

  1. Therese Taylor says:

    Both the poem and the song are brilliant and made me cry. Well done Mitzi. Thanks for staying on top of this.

  2. adawells says:

    I so much enjoyed reading this poem. So many women’s lives are controlled by their next screening appointment. Women are being taught that unless they comply, their bodies are a ticking time bomb just waiting to go off. Screening has taught women to be afraid of their own bodies, to doubt themselves, and to believe that being female is an illness, which requires constant medical surveillance. It is nothing to do with empowerment.

    • bmitzi says:

      Thanks for this comment – much appreciated! I hope to get my poem put on video which may help spread the word – meanwhile, have just posted a few more article links. No time to write more comment but hope you can access, especially Gigerenzer.

      • adawells says:

        Many thanks for the Gigerenzer article, which I was able to access. He is definitely someone I shall be following to read more of his stuff. I have just finished reading your book. I am so sorry for the pain you went through. I too had a very nasty medical experience in 1997. It sounds silly, but it moves me to tears now. I hope you are well, and thank you for doing so much work to make patients lives better than what some of us had to put up with in the 1990’s.

  3. bmitzi says:

    Glad you enjoy Gigerenzer articles. Thanks for reading my book. I’m only sorry you, too, had a bad medical experience and fully understand that it still moves you to tears. I’ve just been in a theatre production that used some of my poems and to begin with I found it quite difficult to recite a particular one – it had the effect of re-enacting what I can only call abuse. But acceptance that this was such wrong practice is very healing.
    I hope you enjoy the videos – link posted today, Sunday 10th.
    Lots of people speaking out now, health professionals as well as patients – BTW – Margaret McCartney’s blog is a great one to follow. And her books – as well of those of Peter Gotzsche, Mike Baum…and Charlotte Williamson’s ‘Towards the Emancipation of Patients’ – must stop…

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