Review of breast cancer screening evidence

Professor Susan Bewley challenged Prof Mike Richards on the evidence for her invite to breast screening, in the BMJ.

He responded by saying a review was already underway, but it sounds like a weird review.

He says that

“An independent review of the research evidence (randomised controlled studies and observational studies) is being undertaken, led by myself and Harpal Kumar, chief executive at Cancer Research UK. We are seeking independent advisers for this review who have never previously published on the topic of breast cancer screening.”

However; Cancer Research UK have a firm policy on screening. It’s here. Basically they want more people to attend for more cancer screening tests.

“We want targeted action to be taken to improve the numbers of people attending screening….

We believe there are several important steps that the Government needs to take to ensure these are met to reduce variations in the screening programmes across the UK. In particular this involves:

  • Ensuring that screening services are adequately staffed to screen people at the appropriate time and provide them with their results quickly;
  • Finding new ways to encourage those who aren’t taking part in screening to participate;
  • Improving the collection of information on how services are running and which people are being left out.”

Nothing about informed consent, informed dissent, choices, weighing up the pros and cons. This is not a neutral position.

The Nordic Cochrane Centre, however, are neutral. They assess the evidence and then they present it. They do not stand to benefit whether they conclude that screening is high gain, low side effects, of vice versa. Their information leaflet is here. They make it clear that there are pros and cons to screening. It is unethical to promote screening without also telling women about the side effects and allowing them a free choice.

I have written a piece in the Independent here and was interviewed on Radio 5 live at about 12 mins in with Professor Peter Gotzsche from the Nordic Centre.

6 Responses to “Review of breast cancer screening evidence”

  1. Chris Hiley October 27, 2011 at 1:06 pm #

    Hello Mgt. You make a most interesting ‘unchariable’ point. And to be clear, I agree. I’m not accusing you of random nastiness. As CR-UK has a half billion pound annual income and ‘we’ seem to have subcontracted cancer policy to them without really noticing, I think ‘we’ can count them as statutory bodies (without the FoI potential, though) in all but name, and be a little more sceptical of them and their motives. Sorry CR-UK. Having half a billion quid does that to you, I’m afaid.

    I’ve just submitted a BMJ Rapid Response to Mike Richard’s thing, under the title ‘Beware: Breast cancer charites operating in this area’. If you happen to read it (if the BMJ approve it) you’ll see I deeply doubt how breast cancer charities can be an honest broker either, in this bit of thinking. Women MAY need independent screening advocacy to get what is required – information for informed choice. Women NO NOT need breast cancer advocacy to nudge them to screening.

    The cancer element is a red herring but we’ll keep being kippered by it.

    Women are unlikely to acquire any transferable ‘thinking about screening’ life skill from the structure, process or outcome of this review. It’d be nice if they did. There are many common screening questions in adulthood, like bowel, PSA (aaagghh) AAA, CT scans (noooo) cervical. I know two of those are ‘men only’ but in some quarters women are lumbered with responsibility for men’s health too. Breast screening is probably their model of how screening works. If they only have a partial grip of the facts – and are unaware it’s partial – they aren’t actually the well informed arbiters of some men’s health choices they are sometimes assumed to be.

  2. Penny Wolff October 27, 2011 at 2:35 pm #

    Spot on as usual, Margaret! I particularly endorse your definition in the Independent – ‘screening = tests for people who have no symptoms of disease’. Apart from the highly questionable ethics of all this (i.e. is it ethical to take a large population of apparently healthy people, to inform a significant proportion that they are actually unhealthy…….)I do wonder, if the aforementioned populations need to be made aware that they are submitting themselves to tests, not only with known percentages of false positives and false negatives, but which AT BEST provide a mere SNAPSHOT IN TIME. Euphoria on receiving a negative result may well be shortlived…….

  3. Samantha October 30, 2011 at 12:32 am #

    thought you would appreciate this young artists (David Foox) work in raising awareness for organ donation. His creepy cute toys stand 3.25″ tall and are one of 24 different body parts.

  4. Mark Struthers November 3, 2011 at 11:27 am #

    I think this rapid response to the BMJ succinctly highlights the dilemmas for patients … and doctors … in the great mammography debate.

    And James Penston’s letter is highly pertinent too.

  5. Mark Struthers November 3, 2011 at 11:39 am #

    Breast screeing is a juggernaut: whatever the outcome of the independent (?) review, it’s going to be virtually impossible to stop it.

    As Lesley Fallowfield said of screening (link above),

    “I feel simultaneously silly for attending but scared not to do so.”

    Breast screening is like playing the lottery or taking your statins … if you don’t, your number will surely come up. We are at High Noon in the age of deception.