More Breast Cancer Screening Frauds
Women undergoing routine breast cancer screening
are not being warned of the risks, with many tests ending in
unnecessary treatment, leading health professionals say.
23 signatories criticise the Government's “unethical”
failure to provide women with the full facts in the NHS programme
of checks for all women aged 50 to 70. Instead, it offers leaflets
that “do not come close to telling the truth”, the
health specialists claim.
Many healthy women are subjected to overdiagnosis of benign
conditions and may undergo unnecessary surgery, radiotherapy
or chemotherapy. If cancers diagnosed by screening were left
to their own devices, many “might never appear in a woman's
natural lifespan”, they add.
The letter comes as the British Medical Journal publishes
tomorrow an analysis by the Nordic Cochrane Centre of breast
cancer and screening. The paper concludes that if 2,000 women
are screened regularly for ten years, one will benefit as she
will avoid dying from breast cancer.
At the same time ten healthy women will be treated unnecessarily,
having part or the whole of a breast removed and receiving radiotherapy
and sometimes chemotherapy. A further 200 healthy women will
have a false alarm.
The Cochrane team, led by Peter Gotzsche, concludes that the
information distributed by the NHS is one-sided and misleading
for screening participants. “The leaflet has the authoritative
title Breast Screening: The Facts suggesting that the information
can be trusted ... [but] it is inadequate as a basis for informed
Of the 2.2million women invited for checks by the NHS breast-screening
programme in 2007/08, 1.7million were screened - up half a million
on a decade ago.
The number of cancer cases detected by screening has more
than doubled over the same period to 14,100 in 2007-08. Of these,
three quarters were invasive cancers — the most dangerous
form of the disease - while 20 per cent were ductal carcinoma
in situ (DCIS) cases.
The Cochrane study observes that, despite this, the NHS leaflet
makes no mention of DCIS cases, of which fewer than half become
Michael Baum, Emeritus Professor of Surgery at University
College London and one of the signatories of the letter, said
there was no evidence that screening was bringing big benefits
and that it was “outrageous that the full facts are not
being set out so women could make informed decisions”.
He said that rather than pushing women into aggressive treatment,
more care should be structured around the “watchful waiting”
approach for prostate cancers - with many men allowed to live
with cancers, and often dying of unrelated causes.
“The number of invasive breast cancers being detected
is not falling, despite the number of cases picked up by screening
rising dramatically,” he said. “You would expect
serious cancers to drop because the early detection means the
DCIS cases are not progressing. It just doesn't add up.”
Margaret McCartney, a GP in Glasgow and another signatory,
said that the pros and cons of screening were not being relayed
to her patients. Women came to her surgery in great anxiety
after a screening recall, without any idea of the fallibilities
of the system through which they were being processed, she said.
Professor Baum said that screening should be revised to focus
on those at most risk through GP assessment, factoring in family
history and demographic trends. “It is complacent and
arrogant to think we should carry on regardless with screening
services. It is time we had a complete rethink, but anyone who
dares challenge the sacred cow of screening has a terrible time,”
Julietta Patnick, director of the NHS breast-screening programme,
said that the leaflets were being reviewed. The programme was
committed to helping women to make informed choices about their
breast-screening invitation, she said. “Part of this is
helping them assess the risks and the benefits of screening
for breast cancer.
“The screening programme produces a variety of leaflets
and has an extensive website to provide the information that
women need to make an informed decision.”
Peter Johnson, chief clinician at Cancer Research UK, said
that while the presentation of information could be debated,
it was dangerous to scare people away from a programme that
had brought substantial benefits.
The NHS programme, which was started in 1990, invites women
aged 50 to 70 to be screened every three years. It is being
expanded to include women from the age of 47 by 2012 as part
of the Government's Cancer Reform Strategy.