No decision about me, without me". What does the Coalition's clarion call to patients actually mean? As a GP, it is my duty to ensure that patients get decent information about the options they have for treatment and to support them in making good decisions. That's what I try to do. Yet when it comes to screening (tests for people with no symptoms of disease) and, in particular, breast screening, the message is rather paternalistic – one of official enthusiasm.
Yet we know that many women who have breast screening are diagnosed with cancer which would never have maimed or killed them, had it gone undetected by screening. This means that there is a risk of overdiagnosis and overtreatment for a "cancer" that was not going to cause harm.
Danish scientists have found that 2,000 women have to be screened for 10 years to delay a single death from breast cancer – but the NHS Breast Screening service takes a different view. It says that 400 women have to be screened for 10 years to prevent one death. Breast screening presents a mixed bag. We should be honest about the problems and women should be left to choose whether or not to be screened.
So it is good that Professor Mike Richards, national clinical director for cancer and end-of-life care, is undertaking an independent review of breast screening. He has said that he only wants researchers who have "never previously published on the topic of breast cancer screening" and is working with Harpal Kumar, chief executive of Cancer Research UK. This raises issues: Cancer Research UK says that it wants "targeted action to be taken to improve the numbers of people attending screening" and that it is "finding new ways to encourage those who aren't taking part in screening to participate".
This is paternalism in action. This review is a waste of time unless it is clear that the patient's autonomy – no decision without me – is respected.
Margaret McCartney is a GP in GlasgowReuse content