Health check: Jury is out on screening

THERE ARE roughly 30,000 medical journals published around the world. An assiduous medical reporter who trawled even 1 per cent of these for unusual or controversial findings could therefore fill several newspaper pages.

However, the standards set by journal editors vary and many are little different from vanity publishers. There are a couple of dozen with a rigorous peer-review process and a reputation that give them clout on the medical world stage. It is safe to say that the Swedish journal Lakartidningen is not one of them.

In more than a decade of medical reporting I do not recall seeing this journal until last week when a study it published appeared in most British national newspapers. It was an analysis of the breast-screening programme introduced in Sweden in the late Eighties which showed that over 10 years there had been no significant fall in deaths from breast cancer.

If confirmed, this is important. Britain based its breast-screening on the Swedish model. We spend pounds 34m a year checking every woman aged 50-64 every three years for signs of breast cancer. Are we wasting our money and could we save more lives by improving treatment for breast cancer sufferers?

Worse, in the Swedish study more than 100,000 women had received a false positive diagnosis - a suspicious mammogram, causing anxiety and distress, which turned out later to be nothing serious. In the course of this, 16,000 women had unnecessary biopsies (samples of tissue taken from their breasts) and 4,000 had surgery to remove a lump - or in some cases the whole breast - which turned out to be healthy. This is a heavy price to pay even for a successful programme and if no lives are being saved then it is unacceptable.

But the Swedish journal, Lakartidningen is little known. So how did the study it published reach the British press? A news report of the study appeared in the "News" section of the British Medical Journal, which functions like a newspaper for doctors, alerting them to developments of interest in the medical world but without subjecting them to the peer-review applied to the journal's original papers. Health reporters scan these pages but somehow, we all missed the Swedish study reported in the March 6 edition of the BMJ until the medical editor of the Daily Mail, who had been on holiday, spotted it the following week. Her front-page story last week ran under the headline "Breast screening `doesn't prevent deaths'".

The story triggered a furious reaction from the National Breast Screening Service. Its press office, fearing a mass defection by women, called news organisations on Thursday morning to alert them to a highly critical letter posted on the BMJ's website. It was from Mans Rosen, deputy director general of the National Board of Health and Welfare in Stockholm which said the Swedish research would not have passed the peer review process for the BMJ or "other distinguished journals". It added that the board had no intention of changing its advice on breast screening "based on such a defective study".

So where does this leave women? The UK breast screening service maintains that at least 1,000 lives a year are being saved although it admits that it will be a year or two more before definitive evidence of this is available. The Swedish researchers maintained that the disparity between the clinical trials of screening, which suggested up to 30 per cent of deaths could be prevented, and the lack of success of the programme reflected the difficulty in spreading a technique nationwide.

This is what lies at the heart of this issue. An idea may work when pioneered in a few centres by highly motivated enthusiasts with exceptional skills. But when run nationally it is only as good as its weakest link. At the moment, breast screening appears to be one of the better programmes and women aged over 50 would be advised to attend for a regular check. But no one can say for certain that it is working until those definitive figures are in.

Arts and Entertainment
Martin Freeman as Lester Nygaard in the TV adaptation of 'Fargo'

Arts and Entertainment
A scene from Shakespeare in Love at the Noel Coward Theatre
theatreReview: Shakespeare in Love has moments of sheer stage poetry mixed with effervescent fun
Have you tried new the Independent Digital Edition apps?
Arts and Entertainment
Dwayne 'The Rock' Johnson stars in Hercules

Arts and Entertainment
Standing the test of time: Michael J Fox and Christopher Lloyd in 'Back to the Future'

Arts and Entertainment
<p>Troubled actor Robert Downey Jr cements his comeback from drug problems by bagging the lead role in Iron Man. Two further films follow</p>

Arts and Entertainment

Arts and Entertainment
Tycoons' text: Warren Buffett and Bill Gates both cite John Brookes' 'Business Adventures' as their favourite book

Arts and Entertainment
Panic! In The Disco's Brendon Urie performs on stage

Arts and Entertainment

Arts and Entertainment
Keira Knightley and Benedict Cumberbatch star in the Alan Turing biopic The Imitation Game

Arts and Entertainment

Arts and Entertainment
Radio 4's Today programme host Evan Davis has been announced as the new face of Newsnight

Arts and Entertainment
Pharrell Williams performing on the Main Stage at the Wireless Festival in Finsbury Park, north London

Arts and Entertainment
Carrie Mathison returns to the field in the fourth season of Showtime's Homeland

Arts and Entertainment
Crowds soak up the atmosphere at Latitude Festival

Arts and Entertainment
Meyne Wyatt and Caren Pistorus arrive for the AACTA Aawrds in Sydney, Australia

Arts and Entertainment
Rick Astley's original music video for 'Never Gonna Give You Up' has been removed from YouTube

Arts and Entertainment
Quentin Blake's 'Artists on the beach'

Artists unveils new exhibition inspired by Hastings beach

Arts and Entertainment
MusicFans were left disappointed after technical issues
Arts and Entertainment
'Girl with a Pearl Earring' by Johannes Vermeer, c. 1665
artWhat is it about the period that so enthrals novelists?
Arts and Entertainment
Into the woods: The Merry Wives of Windsor at Petersfield
theatreOpen-air productions are the cue for better box-office receipts, new audiences, more interesting artistic challenges – and a picnic
Travel Shop
the manor
Up to 70% off luxury travel
on city breaks Find out more
Up to 70% off luxury travel
on chic beach resorts Find out more
sardina foodie
Up to 70% off luxury travel
on country retreats Find out more
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    Backhanders, bribery and abuses of power have soared in China as economy surges

    Bribery and abuses of power soar in China

    The bribery is fuelled by the surge in China's economy but the rules of corruption are subtle and unspoken, finds Evan Osnos, as he learns the dark arts from a master
    Commonwealth Games 2014: Highland terriers stole the show at the opening ceremony

    Highland terriers steal the show at opening ceremony

    Gillian Orr explores why a dog loved by film stars and presidents is finally having its day
    German art world rocked as artists use renowned fat sculpture to distil schnapps

    Brewing the fat from artwork angers widow of sculptor

    Part of Joseph Beuys' 1982 sculpture 'Fettecke' used to distil schnapps
    BBC's The Secret History of Our Streets reveals a fascinating window into Britain's past

    BBC takes viewers back down memory lane

    The Secret History of Our Streets, which returns with three films looking at Scottish streets, is the inverse of Benefits Street - delivering warmth instead of cynicism
    Joe, film review: Nicolas Cage delivers an astonishing performance in low budget drama

    Nicolas Cage shines in low-budget drama Joe

    Cage plays an ex-con in David Gordon Green's independent drama, which has been adapted from a novel by Larry Brown
    How to make your own gourmet ice lollies, granitas, slushy cocktails and frozen yoghurt

    Make your own ice lollies and frozen yoghurt

    Think outside the cool box for this summer's tempting frozen treats
    Ford Fiesta is UK's most popular car of all-time, with sales topping 4.1 million since 1976

    Fiesta is UK's most popular car of all-time

    Sales have topped 4.1 million since 1976. To celebrate this milestone, four Independent writers recall their Fiestas with pride
    10 best reed diffusers

    Heaven scent: 10 best reed diffusers

    Keep your rooms smelling summery and fresh with one of these subtle but distinctive home fragrances that’ll last you months
    Commonwealth Games 2014: Female boxers set to compete for first time

    Female boxers set to compete at Commonwealth Games for first time

    There’s no favourites and with no headguards anything could happen
    Five things we’ve learned so far about Manchester United under Louis van Gaal

    Five things we’ve learned so far about United under Van Gaal

    It’s impossible to avoid the impression that the Dutch manager is playing to the gallery a little
    Screwing your way to the top? Good for Lana Del Rey for helping kill that myth

    Screwing your way to the top?

    Good for Lana Del Rey for helping kill that myth, says Grace Dent
    Will the young Britons fighting in Syria be allowed to return home and resume their lives?

    Will Britons fighting in Syria be able to resume their lives?

    Tony Blair's Terrorism Act 2006 has made it an offence to take part in military action abroad with a "political, ideological, religious or racial motive"
    Beyoncé poses as Rosie the Riveter, the wartime poster girl who became a feminist pin-up

    Beyoncé poses as Rosie the Riveter

    The wartime poster girl became the ultimate American symbol of female empowerment
    The quest to find the perfect pair of earphones: Are custom, 3D printed earbuds the solution?

    The quest to find the perfect pair of earphones

    Earphones don't fit properly, offer mediocre audio quality and can even be painful. So the quest to design the perfect pair is music to Seth Stevenson's ears
    US Army's shooting star: Lt-Col Steven Cole is the man Hollywood calls when it wants to borrow a tank or check a military uniform

    Meet the US Army's shooting star

    Lt-Col Steven Cole is the man Hollywood calls when it wants to borrow a tank or check a military uniform