Screening 'reduces need for breast removal by 40%'

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Screening for breast cancer results in 40 per cent fewer women having to undergo mastectomies and increases the number who can be treated by minor surgery, research has indicated.

Screening for breast cancer results in 40 per cent fewer women having to undergo mastectomies and increases the number who can be treated by minor surgery, research has indicated.

The research provides fresh evidence of the benefits of screening and contradicts claims that regular breast checks do more harm than good by subjecting women to unnecessary operations.

Scientists in Denmark sparked worldwide controversy last year when they said screening led to a 20 per cent increase in mastectomies, largely as a result of the over-diagnosis of benign tumours.

The new study found that the rate of breast-removal surgery almost halved when screening was introduced in Italy and the rate of breast-conserving surgery increased by nearly 50 per cent.

Writing in the British Medical Journal, the researchers argued that screening resulted in the earlier detection of tumours and allowed doctors to use far less invasive techniques. "The rate of breast-conserving surgery has increased significantly with the advent of screening, and the rate of radical surgery has declined significantly. Similar reductions in mastectomy rates have been observed elsewhere," the scientists conclude.

The study involved 60,000 women in Florence, aged between 50 and 69, who were invited for screening between 1990 and 1996 and for subsequent screening at two-year intervals.

The rate of mastectomies fell from 1.08 per 1,000 women in 1990 to 0.62 six years later. During the same period, the rate of breast-conserving surgery increased from 1.18 operations per 1,000 to 1.87.

The decline in mastectomies was paralleled by a drop in the number of late-stage tumours detected, while the increase in breast-conserving surgery was matched by a rise in the number of early tumours uncovered.

Dr Stephen Duffy, a scientist from Cancer Research UK who was one of the authors of the study, said: "Some scientists believe screening programmes could be harmful to women by increasing the rates of aggressive treatments such as mastectomy.

"But this study shows that screening actually reduces the need for major surgery by detecting the disease before it spreads.

"When breast cancer is caught early, women can be treated with less invasive surgery such as lumpectomy, where only the tumour and a section around it is removed from the breast."

Breast cancer is the most common malignancy in women in the UK, with nearly 40,000 cases diagnosed each year and almost 13,000 deaths.

The British screening programme, which began in 1988 and offers checks to all women aged 50 to 64 every three years, is credited with saving 1,250 lives annually.

Confidence was dented last year when Ole Olsen and Dr Peter Gotzsche of the Nordic Cochrane Centre inCopenhagen said there was "no reliable evidence" that screening saved lives and that it led to needless mastectomies.

Earlier this year, 24 experts assembled by the World Health Organisation said that deaths from breast cancer were reduced by 35 per cent among women aged 50 to 69 who were screened regularly.

Dr Duffy said: "Statistics show that minor operations are replacing radical surgery in the treatment of breast cancer as a direct result of screening."

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