Leading article: Time for a fresh look at cancer screening

Share
Related Topics

Should the NHS be screening for breast cancer? That may seem a question with a self-evident answer but the pages of the British Medical Journal have been crackling for the past six months with a dispute over the issue, since a Danish study questioned the benefits of screening. It emphasised the harm caused by over-diagnosis – where a cancer is detected that would never have become harmful – and the psychological stress, painful investigation and unnecessary treatment that follows. Supporters of breast cancer screening have howled in alarm at the damage such reports do to the uptake of mammography. Critics of the programme have accused them of substituting medical propaganda for proper scientific judgement.

In an attempt to resolve the problem, the BMJ commissioned Klim McPherson, a respected Professor of Public Health Epidemiology at the University of Oxford, to review the evidence. Alarmingly he has concluded that screening for breast cancer has only limited benefit, may harm individual women and is of "marginal cost effectiveness" for the community. The time has come, he suggests, for a serious scientific rethink of the benefits of the £75m-a-year NHS screening programme.

The Government should take note of this, particularly at a time when the nation cannot afford public spending which is ineffective. The danger is that it will not dare do so, for fear of the public outcry which would ensue – as happened in the United States when the US Preventive Services Task Force recently recommended that screening should not begin until the age of 50 (it was 40) and should take place only every two years rather than annually. The proposal provoked outrage from screening enthusiasts.

Consider the facts. There are both benefits and risks in screening the whole population for a particular disease when they reach a designated age. Common sense says that any kind of screening must be helpful, since it gives an advance warning and enables early treatment. But common sense is not always the most reliable guide to matters of science. The benefits easily outweigh the risks with some diseases, like bowel cancer, where diagnosis is straightforward and treatment is unambiguous and overwhelmingly successful. But with diseases like prostate cancer the diagnostics are highly unreliable and have, in the US, produced an epidemic of unnecessary treatment in a disease which can be so benign that many sufferers live for decades and die of something else before the cancer becomes anywhere near lethal.

With breast cancer, risks and benefits are more finely balanced. Detecting invasive tumours before they are clinically apparent is obviously a good idea. But screening will also detect tumours that are not going to cause trouble. Mammography itself is minimally carcinogenic. Intensive screening programmes have uncovered a new type of breast cancer – ductal carcinoma in situ – about which comparatively little is known, so that judgements on risks versus benefits are being made on statistics which are very imprecise. And screening all women aged 50-70 every three years is expensive; the money might be better spent on improved treatment.

Most alarming is Prof McPherson's suggestion that the case for an important national screening programme has been taken as an article of faith and not subjected to proper scientific scrutiny. Rather it has been led by "agenda-driven analyses" and "obfuscation from organisers of mammography services".

These are grave charges. The Government should commission a full and dispassionate examination of individual patient data from all recent studies to address the many unanswered questions. In the meantime, the NHS screening programme needs to be clearer about these uncertainties when communicating with people who need complete honesty if they are to make informed decisions about the benefits of screening.

React Now

Latest stories from i100
iJobs Job Widget
iJobs General

Recruitment Genius: Company Commercial / Company Property Solicitor

£30000 - £45000 per annum: Recruitment Genius: This south Warwickshire based s...

Selby Jennings: Leveraged Finance - Senior Associate - International Bank - Frankfurt

Competitive + bonus: Selby Jennings: My client, a growing European CIB are loo...

Savvy Media Ltd: Media Sales executive - Crawley

£25k + commission + benefits: Savvy Media Ltd: Find a job you love and never h...

Austen Lloyd: Corporate Solicitor NQ+ Oxford

Excellent Salary: Austen Lloyd: CORPORATE - Corporate Solicitor NQ+ An excelle...

Day In a Page

Read Next
 

Daily catch-up: Old London Bridge; how to fight UKIP; and wolves

John Rentoul
Muslim men pray at the East London Mosque  

Sadly, it needs to be said again: being a Muslim is not a crime

Yasmin Alibhai Brown
In a world of Saudi bullying, right-wing Israeli ministers and the twilight of Obama, Iran is looking like a possible policeman of the Gulf

Iran is shifting from pariah to possible future policeman of the Gulf

Robert Fisk on our crisis with Iran
The young are the new poor: A third of young people pushed into poverty

The young are the new poor

Sharp increase in the number of under-25s living in poverty
Greens on the march: ‘We could be on the edge of something very big’

Greens on the march

‘We could be on the edge of something very big’
Revealed: the case against Bill Cosby - through the stories of his accusers

Revealed: the case against Bill Cosby

Through the stories of his accusers
Why are words like 'mongol' and 'mongoloid' still bandied about as insults?

The Meaning of Mongol

Why are the words 'mongol' and 'mongoloid' still bandied about as insults?
Mau Mau uprising: Kenyans still waiting for justice join class action over Britain's role in the emergency

Kenyans still waiting for justice over Mau Mau uprising

Thousands join class action over Britain's role in the emergency
Isis in Iraq: The trauma of the last six months has overwhelmed the remaining Christians in the country

The last Christians in Iraq

After 2,000 years, a community will try anything – including pretending to convert to Islam – to avoid losing everything, says Patrick Cockburn
Black Friday: Helpful discounts for Christmas shoppers, or cynical marketing by desperate retailers?

Helpful discounts for Christmas shoppers, or cynical marketing by desperate retailers?

Britain braced for Black Friday
Bill Cosby's persona goes from America's dad to date-rape drugs

From America's dad to date-rape drugs

Stories of Bill Cosby's alleged sexual assaults may have circulated widely in Hollywood, but they came as a shock to fans, says Rupert Cornwell
Clare Balding: 'Women's sport is kicking off at last'

Clare Balding: 'Women's sport is kicking off at last'

As fans flock to see England women's Wembley debut against Germany, the TV presenter on an exciting 'sea change'
Oh come, all ye multi-faithful: The Christmas jumper is in fashion, but should you wear your religion on your sleeve?

Oh come, all ye multi-faithful

The Christmas jumper is in fashion, but should you wear your religion on your sleeve?
Dr Charles Heatley: The GP off to do battle in the war against Ebola

The GP off to do battle in the war against Ebola

Dr Charles Heatley on joining the NHS volunteers' team bound for Sierra Leone
Flogging vlogging: First video bloggers conquered YouTube. Now they want us to buy their books

Flogging vlogging

First video bloggers conquered YouTube. Now they want us to buy their books
Saturday Night Live vs The Daily Show: US channels wage comedy star wars

Saturday Night Live vs The Daily Show

US channels wage comedy star wars
When is a wine made in Piedmont not a Piemonte wine? When EU rules make Italian vineyards invisible

When is a wine made in Piedmont not a Piemonte wine?

When EU rules make Italian vineyards invisible