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Better safe than sorry

Posted on 20. Feb, 2009 by chiantichiara in Health, News

I read an interesting letter in The Times about the negative consequences of the NHS Breast Screening Programme. To be honest, I was slightly taken aback by the title as I didn’t think there was anything downbeat that could be said of a service that saves 1,400 lives every year. However, according to a group of leading health professionals spearheaded by Professor Michael Baum, emeritus professor of surgery at University College London, the NHS are providing misleading and one-sided information to women being invited to attend a screening. Apparently these women are not being informed of the negative risks of having a mammogram; being diagnosed a ‘false positive’. In other words being diagnosed and treated (undergo surgery, chemotherapy and radiotherapy) for breast cancer when in fact they are healthy. A false alarm if you will. My emotional side jumped up first in response to this news – what a terrible position to find yourself in. I can only imagine, but I believe a false diagnosis could inflict significant psychological, let alone physical damage, to any woman. Then my rational (or insensitive) side posed the first question – hang on a minute, how common are these false alarms?

My answer wasn’t far away as it transpires that this letter was published at the same time as the Nordic Cochrane Centre published an analysis of breast cancer and screening in the British Medical Journal. As I understand it, these false alarms all centre round the diagnosis and treatment of ductal carcinoma in situ (DCIS). Fewer than 50% of DCIS cases detected by mammography become invasive cancers yet a few women diagnosed with DCIS get labelled as ‘cancer patients’ and go on to be treated unnecessarily. To put it into context, according to the study, for every 2, 000 women screened over a 10 year period – one will have her life saved, 200 women will receive false alarms (but no treatment) and 10 women (0.5%) will go on to have unnecessary treatment.

It is precisely these statistics that, according to Professor Baum and the Cochrane Group, are missing from the NHS leaflets and consequently women aren’t being provided with the information to make an informed decision about whether they should attend a screening or not.

The thought that a woman may not attend a screening if she thinks it’s not appropriate to her is frightening. However intelligent and informed, how could any woman possibly judge this herself? Have you not heard of the ‘yeah, but it won’t happen to me’ syndrome that is rife across all levels of society? Of the 2.2 million women invited for checks by the NHS Breast Screening Programme in 2007/08 only 1.7 million were screened. That leaves another 0.5 million women between 50 and 70 years old who didn’t attend. People need very little encouragement not to see a doctor (see recent blog entry). I can tell you straight, if my mum ever echoes the sentiments of this letter and says, “Well darling I really don’t think I need to attend my mammogram because chances are they won’t find anything and even if they do it’ll probably be a false alarm or I’ll end up being unnecessarily treated,” I will drag her to the clinic by her ear. Fortunately for her, she’s much more responsible than that.

Whilst I am all in favour of the informed and empowered patient, and the Department of Health’s initiative to ‘put information at the centre of health’, we have to tread a fine line when disseminating disease awareness information to the public. Yes, if the NHS Breast Screening Programme information leaflets are not factually accurate and balanced then this needs to be addressed (as they state they will), but we mustn’t forget the MMR lesson learnt only a short time ago. Dr Wakefield’s erroneous study and the subsequent media hysteria has directly led to the increased cases of mumps and measles we see today in unvaccinated children.

Breast cancer will affect one in every nine women at some time in their lives and the NHS Breast Screening Programme has worked tirelessly for almost 20 years to ensure women get diagnosed and treated as early as possible to prevent any tragic outcomes. In the UK, more than 100 women a day are diagnosed with breast cancer and in England a third of all cases are picked up through the NHS Breast Screening Programme. What’s more the programme is being expanded to include women from the age of 47 by 2012 as part of the Government’s Cancer Reform Strategy. Nowadays 80% of women diagnosed with breast cancer today will survive for at least five years compared to only half in the ‘70s. Yes this also has a lot to do with improvements in drug therapy and I understand that no screening programme is 100% perfect, but these are wonderful survival statistics and it would be terrible to see a sudden rise in breast cancer rates because women have been scared away from this programme.

Tags: NHS