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
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
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.'
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