Cancer specialists question value of breast screening programme

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Health Editor

A second cancer specialist has called for a review of the national breast- screening programme, as scores of women cancelled appointments for X-rays yesterday because of renewed concern over their value.

Professor Gordon McVie, scientific director of the Cancer Research Campaign, said the Government should reconsider the value for money of a programme that costs pounds 27m a year.

Quoting Canadian research into mass screening, Professor McVie said: "We have to ask if a 5 per cent cut in mortality worth the money?" He appeared to support Professor Michael Baum, a consultant surgeon at the Royal Marsden Hospital, London, who resigned from a government advisory committee on screening in April because he no "longer shared the ethos of the committee and wanted the freedom to discuss the [screening] issue."

Professor Baum, a long-standing critic of the NHS breast-screening programme, believes the money spent on screening 1 million women each year could be better invested in research into breast cancer.

In a statement released yesterday, Professor Baum, a former director of research at the Institute of Cancer Research said: "I wanted to question the cost effectiveness of the programme and to suggest that at times of cutbacks in the funding of cancer research that it would be better value for money to invest in improving treatment rather than improving screening.

"It must be understood that for every 1,000 women screened over a 10- year period only three are likely to benefit. Whereas with an effective treatment programme for every 1,000 patients treated 100 might benefit over a period of time."

Professor Baum denied that he thought screening should be "scrapped" as reported, and said screening under some circumstances would achieve a modest reduction in deaths.

In a letter to the Lancet last month, Professor Baum said screening units should develop into "open access, super specialist clinics for women with symptoms [of breast disease]".

However, Robert Mansel, professor of surgery at the University of Wales College of Medicine in Cardiff, who has set up such a clinic, said it was only possible because of the "kick-start" given to services by the NHS screening programme.

He said it was too early to question the impact of the programme and at least seven years' experience was needed before a true evaluation could be made. "Baum makes some valid points but it is not yet the right time to be reviewing screening," he said.

Julietta Patnick, national co-ordinator for the NHS breast-screening programme yesterday defended it by saying it was the "only proven protection for women from breast cancer". She said it was estimated to save 1,250 lives out of 1 million women screened each year.

A spokeswoman for the programme said that many of the 90 screening centres were reporting that women had cancelled their appointments following Professor Baum's statement. "These stories are so negative and our main concern is that there is a woman out there with undetected breast cancer who is not coming forward for screening."

A spokesman for the Department of Health said the Government remained committed to the programme, although Dr Baum's views would be considered seriously.

Doubts about the programme have surfaced periodically since the Government announced in 1987 that it was setting up a national screening programme for women aged 50-64. They resurfaced following a major Canadian study published earlier this year suggested that national screening would cut deaths by only 5 per cent, conflicting with previous studies which estimated a reduction of up to 30 per cent.