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.

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