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Breast Screening Myths: 7000 Women Per Year Are Wrongly Told They Have Cancer

More than 7,000 women a year screened for breast cancer are wrongly told they have the disease, it was claimed yesterday.

The misdiagnoses lead to unnecessary treatment, including mastectomies.

After an independent review of the NHS programme for women aged 50 to 69, scientists concluded that the benefits of screening have been exaggerated and women are not warned of the potential harms from having regular checks.

It says there is 'no convincing evidence' to support the Department of Health's assertion that screening saves 1,400 lives a year.

Improvements in breast cancer survival in recent years are more likely to be attributable to advances in treatment rather than screening, says the review by the Nordic Cochrane Centre in Copenhagen.

Under the NHS breast screening programme, women aged 50-69 are invited for routine mammograms, or X-rays, every three years. Altogether 1.7million year take up the invitation.

Controversy has increased in recent years about the benefits, with critics complaining women are told too little about possible harms such as unnecessary biopsies.

More worryingly, they include treatment for a disease a woman does not have or for slow-growing or dormant tumours that would not have produced any symptoms in her lifetime.

Screening picks up more cases of ductal carcinoma in situ (DCIS) - cancer in cells lining the milk ducts that has not spread - than would normally be found because it is often symptomless.

Doctors are uncertain about the best way to treat them and accept some would never become life-threatening cancers.

Yet half of women diagnosed with DCIS have a breast removed.

The review found 21,000 women in the 50 to 69 age group had breast cancer diagnosed by screening in 2007.

Professor Peter Gotzsche, the lead author of the review, said one in three of the cancers diagnosed could be 'unnecessary' diagnoses of benign DCIS. He said: 'Each year 7,000 women in the UK receive an unnecessary breast cancer diagnosis and unnecessary breast cancer treatment because of overdiagnosis in the NHS breast cancer screening programme.'

The review, published in the Journal of the Royal Society of Medicine, says the screening programme's annual report published by the Department of Health in 2008 'exaggerates the benefit, omits the harms, and looks like propaganda aimed at persuasion'.

The calculations on which the department says 1,400 lives are saved by screening each year are wrong, says the review.

It concludes: 'It is not possible to save three women out of 1,000 from dying from breast cancer through ten years of screening.' The actual figure based on systematic scientific evidence is closer to one woman per 2,000 screened over ten years, says the review.

'There is no convincing evidence that screening has saved lives,' says the review. 'In fact, the effect of 20 years of screening in the UK is not visible in the mortality statistics.

'In contrast, there is solid evidence of serious and common harms, and the screening programme is very costly. Does this not mean it is time for an impartial review of the justification for mammography screening?'

Julietta Patnick, the director of the NHS Cancer Screening Programmes, rejected the study's findings. She said: 'Numerous independent studies have shown screening reduces mortality.

'A report from the World Health Organisation's International Agency for Research on Cancer concluded there is a 35 per cent reduction in mortality from breast cancer among regularly screened women aged 50 to 69 years.'

Case study

Last week it emerged that Susan Gilmore was the 19th woman to have been wrongly given the all-clear for breast cancer at a hospital in Lancashire after screening errors.

In September it was revealed the women had been misdiagnosed by a radiologist at the Accrington Victoria Community Hospital.

Ms Gilmore was also called back and later had a mastectomy.

East Lancashire Hospitals NHS Trust admitted she is the 19th woman who was misdiagnosed and has apologised.

Mrs Gilmore, from Earby in Barnoldswick was given the all-clear by the same radiologist at the hospital in 2002 and 2005, outside of the period under review.
She found out that she had the disease after being recalled for a third time in December 2008 to a different consultant.

'It was only after I read about it, because I wasn't one of the 18 who were [originally] recalled,' she said.

'Once I'd read those reports I started to mull things over in my mind and thought, it's going to be this man, it's going to be this same consultant who sent me home twice.'

The original blunder came to light through internal monitoring in the screening service which sparked an independent investigation, revealed in September 2009.

Of the 355 cases reviewed in the study, 85 women were re-tested and 14 were diagnosed with invasive breast cancer. A further four had a non-invasive cancer which had not progressed.

The radiologist involved last screened patients in December 2008 and has been suspended since April 2009.

Dr Richard Dobrashian, director of the East Lancashire breast screening programme, said: 'We have now included Mrs Gilmore in the reviewed ladies so the 18 has become 19 in the misdiagnosis by this particular radiologist.'

Seven of the women who were wrongly given the all-clear have instructed solicitors to fight for compensation.



January 20, 2010
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