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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 consent.”

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 invasive cancers.

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,” he said.

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.

Reference Source 172
February 20, 2009

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