Abreast of the matter

I am reporting good news, for a change. The UK Breast Screening Service has said it intends to rip up the leaflet which is currently sent to women with breast screening appointments. A recent paper in the British Medical Journal outlined the kinds of uncertainties and likelihoods the authors thought would have counted as “fair information” to give to women. This seems to have prompted UK Breast Screening to review the content of its leaflet and try to give better information.

I am a GP, and so my perspective on what is “better” will likely take account of the difficulties which I observe breast screening leading to. My wish list starts with wanting the new leaflet to describe screening explicitly as an intervention which one can accept or decline. Breast screening should not be something which is sold, or which one is persuaded or coerced into. Women should be treated as competent adults who have the pros and cons explained to them: it is simply not ethical for breast screening to proceed without proper counsel.

People have written entire books about the problems of screening. I will stick to just two things: “overdiagnosis” of what is sometimes called “pseudodisease”, and limited gain. “Overdiagnosis” relates to the fact that it’s not just full-blown cancers that are detected. Some of the abnormalities seen and biopsies examined can represent situations where the prognosis is uncertain. Some of these are a condition called “ductal carcinoma in situ”. This makes up about 20 per cent of “breast cancer” diagnosed at screening in the UK. While these are commonly treated with surgery and possibly chemotherapy and radiotherapy, only a minority may end up progressing to a life-threatening cancer. Studies done at autopsy imply that 15 to 39 per cent of women die with, rather than from, this type of cancer.

The remainder of the article can be read here. Please post comments below.

2 Responses to “Abreast of the matter”

  1. Susan Pyett March 3, 2012 at 2:57 pm #

    My story is a very long one, I will endeavour to simplfy it.
    1) Regularly attended Screening programm from the age of 50yrs.
    2) Had symptom inbetween screening ie after 19 months.
    3) GP exam, appiontment made with Hospital.
    4)Consultant exam,I informed them of my last mammogram. Mammogram at hospital, result clear, was discharged.
    5)Six weeks later I was called back after comparison was made with previous mammogram 19months earlier.
    6)Mammogram number three was done followed by Ultrasound.
    7) Results show I have a problem.
    8)Ultrasound with core biopsy.
    9)Two months after my GP appointment I was diagnosed with invasive lobular breast cancer. ( it dosen’t show up on Mammograms, refer to cancer uk web site.)

    The new pamphlet for breast screening advises women to be breast aware, which I was. It also states to go to your doctor with any symtoms, which I did. It also states that not all cancer show up on mammogram, which I know. If this is the case then why was I not and women like me given a MRI or Ultrasound at the first hospital appointment? Cancer can develop 6/12/18/24 months after screening. There is no point in giving this information to women if they are being let down by follow up screening at hospital. Small aggresive cancer are life threatening and can spread in a very short time.The need to use every possible way to detect it as early as possible can save many more lives.

    ,

  2. Margaret McCartney
    margaretmccartney March 3, 2012 at 6:50 pm #

    Dear Susan
    unfortunately I don’t think that screening is that simple or clear cut. Can I suggest that you might like to read this book http://www.amazon.co.uk/Mammography-Screening-Truth-Lies-Controversy/dp/1846195853 about the history and evidence behind breast screening. Even MR and ultrasound are not well evidenced as screening tools. What seems to make the difference now is the excellent treatment for breast cancer when they are found symptomatically and I wish you all the best.

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