Breast Cancer Screening – how does the NHS BSP shape up against updated guidelines?

A recently published document sets out the updated criteria for the UK National Screening Committee’s (UK NSC) evidence review process.
4. 11 states: “There should be evidence from high quality randomised controlled trials that the screening programme is effective in reducing mortality or morbidity”…
4.12 states: “…There should be evidence that the complete screening programme (test, diagnostic procedures, treatment/ intervention) is clinically, socially and ethically acceptable to health professionals and the public…”
4.13 states: “The benefit gained by individuals from the screening programme should outweigh any harms for example from overdiagnosis, overtreatment, false positives, false reassurance, uncertain findings and complications.”
4.14 “The opportunity cost of the screening programme (including testing, diagnosis and treatment, administration, training and quality assurance) should be economically balanced in relation to expenditure on medical care as a whole (value for money). Assessment against this criteria should have regard to evidence from cost benefit and/or cost effectiveness analyses and have regard to the effective use of available resource.”
Given the findings of the Independent Review, the Parliamentary Inquiry and recent robust research, (see earlier posts) it’s difficult to see how the current breast screening programme meets the above criteria.
And just where does the Age Extension Randomised Controlled Trial (without a properly informed consent process) stand now?
Criteria for appraising the viability, effectiveness and appropriateness of a screening programme

Guidance: Evidence review criteria: national screening programmes –
updated 23 October, 2015.
………………………………………………………………………………………………………………………………
An open access paper that has just become available online is very pertinent given the new ACS guidelines (see earlier post). It’s meant to help GPs explain some of the difficult issues around breast screening and lay to rest old misconceptions and outdated propaganda messages.

Four principles to consider before advising women on screening mammography.
John D. Keen, MD, MBA, Karsten J. Jørgensen, MD, DrMedSci. Journal of Women’s Health.Vol 24, No 11, 2015.

http://online.liebertpub.com/doi/pdfplus/10.1089/jwh.2015.5220

……………………………………………………………………

And a superb paper which discusses disease-specific mortality and all-cause mortality as an end point in randomised cancer screening trials (William C Black, David A Haggstrom and H Gilbert Welch. JNCI J Natl Cancer Inst, vol 94, Issue 3, pp 167-173) can be found at: http://jnci.oxfordjournals.org/content/94/3/167.full

Advertisements

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, guidelines, harms, healthcare modernisation and tagged , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s