Choices for screening and paternalism

Luisa Dillner wrote a statistically correct and informative article about breast screening in the Guardian recently; she has been replied to by Chris Askew, the chief executive of Breakthrough Breast Cancer. He makes a big  mistake. In his first paragraph, he says “Breakthrough Breast Cancer hopes this will not discourage women from attending their breast-screening appointments”. Later on, he says “The choice to attend breast screening can only be made by the individual, and women are encouraged to read the information leaflet that accompanies all invitations for screening”.

It does not add up. If you want to give women fair choices,  you do not tell them what they should decide. If you want to campaign for women to take up screening appointments, you are making the decision for them.

Breast cancer charities in the UK are in a position of power, unfortunately. If they wanted to do some good, they could accept that screening is not a great test, and that women deserve better information and the ability to make a ‘choice’ – not a pre-booked appointment, assuming consent. Women are being served badly by breast cancer charities who continue to push breast screening,  rather than realising that is is a test with numerous hazards and problems.

Two doctors from the Nordic Cancer centre have a paper in today’s JRSM about the lack of fair information on breast screening invitations – “Concerns about over-diagnosis have not been addressed either and official documents still downplay this most important harm of breast cancer screening.”

Why is this still going on? We need some sort of coalition For Sensible Screening to speak out more – anyone up for it?

3 Responses to “Choices for screening and paternalism”

  1. Chris Hiley September 5, 2011 at 8:03 am #

    Hello Margaret,

    I am! But I don’t know anything useful, except how agree with you! I will stick a link on my blog to this bit tho’. I can do that.

    I deconstructed Chris Askew’s press release, as quoted on Channel 4’s news website on the same thing (at my ususal interminable length. Sorry.) See ‘Breast screeing an unCharitable view’

    I’m a person in the population of interest in the breast screening debate, but hands up who’d expect to see a women with breast cancer – who isn’t – taking ‘my’ space on, say, a day time TV sofa?….. I blame the breast cancer charities myself. Hence my unCharitable view…

    I came over all smug when I realised that framing breast screening as a screening issue, not a cancer one alters perspective markedly. And, as I may have mentioned before, my letter inviting me for breast screening never mentioned cancer ….. so I am correct, not just striking a pose for effect. I was even more pleased to find I hadn’t finally left Planet Real Woman for good when you expressed similar point of view. Ha!

  2. Margaret McCartney
    margaretmccartney September 5, 2011 at 10:18 pm #

    lovely blog, Chris.
    SO: the public health doctors who have been in touch are a little bit reluctant to speak up. Many patients don’t know that they are being oversold screening….there will be loads about this in the book, which I hope will keep chipping away – it’s all a bit disheartening, really….

  3. Chris Hiley September 6, 2011 at 11:04 am #

    Thanks. I’m an aquired taste! Daily readership consistent – WELL into the fours or fives. I like the look of the book. Off I go, up (or is it down?) the Amazon!