The jury remains out on the efficacy of screening programmes generally, and on breast cancer screening specifically.

Over the past few years there have been academic studies and independent panel reports which have supported screening, matched in almost equal measure, by others that call such programmes into question. The latest screening 'scare' reported by the BBC in May 2018 revealed that a computer error had led to over 450,000 women not being screened. This prompted the usual flurry of accusation and counter-accusation and then the story went very quiet.

To screen, or not to screen?

A letter to the Times from a group of 15 academics and doctors suggested that those women who had not been invited to be screened were, in fact, better off on the basis that screening does more harm than good. NHS figures seem to confirm this: for each life saved as a result of screening, three women end up having unnecessary treatment. More recently an academic study suggests that screening programmes should be adjusted to women's risk profiles, but that this approach required a balanced view of benefit versus harm. Some people would argue that every life saved is worth the cost of unnecessary treatment; others would argue that avoiding unnecessary treatment is worth the cost of a small number of deaths. As Dr Pashayan, who led the study, commented: "How many deaths are you willing to accept to prevent overdiagnosis? It has to be in discussion with women . . . it's a value judgment. It's not scientific." We seem to be presented with Solomon's choice.

Oxford study calls screening into question

But this study reflects one carried out by Oxford University in 2013 which looked at deaths from breast cancer over a 39 year period (so included pre-screening era data). The results were drawn from an analysis of death certificates in the Oxford region, which specifically recorded breast cancer as a cause of death, as well as general data from England as a whole where breast cancer was recorded as the underlying cause of death.

The results concluded that screening was not a significant factor in the overall reduction in deaths from breast cancer not least because the group showing the fastest decline in mortality rates was women under 40 who are not part of the screening programme. However, the lead researcher did concede that screening may well be effective at a detecting cancer in individual women but maintained that the "the effects are not large enough to be detected at the population level".

Sir Robert Peel hospital loses its mobile screening unit

That may provide some comfort for those women who live in south Staffordshire who were alarmed at the news that the Sir Robert Peel Hospital in Tamworth has suspended its mobile screening service due to building works, meaning that they would have to travel to Queen's Hospital, Burton on Trent, some 20 miles away. Those who don't drive confessed that they might skip their three year check rather than face a 40 mile round bus trip. This situation confirms the importance of giving women all the information, both positive and negative, about screening so that they can carry out their own risk analysis and make an informed decision.

Overall, the consensus remains in favour of screening although it is clear that greater awareness, self-examination, lifestyle changes and improvements in treatment methods play a large part in decreasing mortality rates. If you have any concerns about the results from breast screening or any other aspect of cancer treatment, I am happy to have an initial discussion to see whether or not we can help.

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