Breast screening challenged (again)

Surely we shall see some progress on proper information about breast screening soon?

From this week’s BMJ: basically, improvements in breast cancer treatment, not access to breast screening, can explain improvements in mortality from the disease.

This is important information for women who are deciding whether or not to have breast screening. As I’ve said before, the main problem is that women don’t realise they have a choice – they often feel that there is no real ‘choice’ and it’s simply a test that they should do.

Colleagues including Prof Mike Baum, and myself co-signed a letter which was published in the Times at the weekend calling for an independent review; I think a NICE review is essential. Mike has written a good piece today following this up in the Guardian.

We have to start being more honest with people about the hazards of screening rather than just the potential benefits. At the moment people get information designed to persuade them to accept screening, not to make an adult informed choice. This is a core GMC duty of a doctor, quite apart from anything else. This subject is at the heart of what the book will be about, out in Jan.

6 Responses to “Breast screening challenged (again)”

  1. flaminorajack August 4, 2011 at 11:46 am #

    sorry off subject but didn’t know how else to put this to you and your readers.

    ATOS.. how come, people doing the smae assessment are paid different rates, GMC registered doctors get up to £60k whereas NMC Registered NUrses and HPC registered Physiotherapists get maximum of £34k? For doing the same ATOS WCA assessments and ticking the same boxes.

    I think I’d be a bit pissed off… then again ATOS know how to be fair, truthful, equitable, reasonable and accurate in what they do. NOT. Go on sell your souls for a bag of gold coins. Professional, ethical or bringing the professions into disrepute?

    see their recruitment advertisment at

    Discover a rewarding work/life balance.

    NMC Registered Nurses £32k-£34k (Depending upon location)

    GMC Registered Doctors Full-Time or Self-Employed
    £60k (Depending upon location) or fee-per-case basis

    HPC Registered Physiotherapists £32k-£34k (Depending upon location)

    Mon-Fri from 22.5 to 37 hours per week.

    No weekends or bank holidays.

  2. Margaret McCartney
    margaretmccartney August 4, 2011 at 1:17 pm #

    please don ‘t put me in the position of defending atos!
    you can post on one of that atos threads below if you want.
    they would say drs get paid more because they can do any assessment, whereas nurses and physios can’t do ‘neurological’ problems.

  3. Margaret McCartney
    margaretmccartney August 4, 2011 at 1:17 pm #

    and also many drs will earn much less because they are paid per case. there are targets to meet.
    this is not a defence of atos – am explaining more than anything..

  4. Chris Hiley August 4, 2011 at 4:05 pm #

    Aha! Yes! I’ve just half written and failed to ‘post’ some idle speculation on my blog, about how on earth women who work for breast cancer charities make their own informed decisions about the pros and cons of of breast screening. Does their professional environment tightly circumscribe their personal decisions? Some staff will be women with breast cancer, after all, and I’m pretty certain they will feel they have the right to an attitude or input to any individual staff member’s breast screening choices. In the absence of evidence I predict the only choice, for them is the one to go for screening – with reasons taht are little to do with health. Maybe.

    Do any women staff decide not to have screening, and how does that work for them if they do? They’d make an interested case study for the media but that’s not one I’d expect to see any breast cancer charity offering any time soon. Besides, I’m guessing there won’t be many staff over 50, for whom any such dilemma might occur.

    I’ll go back sometime, sort it out and stick it on t’web.

    I have just posted some ropey sociology (it makes sense to me, but a proper sociologist will undoutedly have a conniption fit over it) because I think the battle for accurate information and the reluctance to supply it, is about something more complicated. I haven’t quite grasped what yet, but I will. I’m re-visiting the un-ease I felt refusing the chance for a screen – not to do with the huge risk of dying from breast cancer to some people think I may have rashly exposed myself – hhmmmm – but to do with the risk of upsetting my friends with breast cancer.

    And I did rapidly respond on BMJ as you suggested helfully the other day, but could only attach it to the bit you wrote on unethical screening. It still made sense but I missed the chance to poke fun at those blimin’ charity press releases and naff charidee rhetoric!

    best wishes @ChrisHiley

  5. Elizabeth (Aust) August 6, 2011 at 10:22 am #

    It’s the same with cervical screening – all of this has concerned me for years – why has it taken so long for doctors and the Govt to develop one shred of respect for informed consent for women – something men enjoy with prostate screening?
    Far more women are harmed by these programs, but the attitude seems to be, that if we keep women ignorant and grateful, we’ll be fine and safe from legal action. No need to make any changes, no need for honesty or ethical conduct.
    I was delighted to hear Prof Baum and others are thinking of taking legal action against the NHS – I wish someone would do something in Australia – we’re still pap testing women under 30 and screening all women every 2 years – it’s an exercise in maximizing the harm to healthy women – a rare cancer has been turned into a major “health” concern for all women. Vested interests will keep over-screening alive for as long as possible. It’s awful to see the damage these programs causes to healthy women. Thank goodness I got to the truth and have never taken part in these “life-saving” tests.
    It has shaken my faith and respect for the medical profession.
    It’s all targets and incentive payments down here, zero respect for women and informed consent.
    Breast Screen are pushing for 70% of women to screen – well, those in the target age range, 50 to 69 – to hell with informed consent – it’s justify this expensive program! Last time I checked they didn’t even mention over-diagnosis in their brochure.

  6. Margaret McCartney
    margaretmccartney August 10, 2011 at 8:19 pm #

    thank you
    perhaps Elizabeth you’d like to respond on the BMJ website where there have been some ‘interesting’ responses from people involved in screening….