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Breast cancer screening is to be reviewed, cancer tsar announces


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BMJ 2011; 343:d6905 doi: 10.1136/bmj.d6905 (Published 26 October 2011)

Cite this as: BMJ 2011; 343:d6905

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    Breast cancer screening is to be reviewed, cancer tsar announces

    • Nigel Hawkes
    • +Author Affiliations

      The leaflet sent to women in England who are called for breast cancer screening is to be rewritten for the second time, and the effectiveness of screening is to be reviewed by an independent panel, as the Department of Health moves to resolve growing doubts over the programme.

      The undertakings are announced today in the BMJ by the national cancer director, Mike Richards (BMJ 2011;343:d6843, doi:10.1136/bmj.d6894). Although he backs the advice of the Advisory Committee on Breast Cancer Screening that the programme saves lives and does more good than harm, he says that he will have no hesitation in putting a contrary view before ministers if the review should reach a different conclusion.

      He has also promised a new approach to writing the leaflets for each screening programme, with the breast screening leaflet—described by critics in a letter to the Times as “patronising, coercive in tone, and parsimonious with the facts”—as one of the first. An independent team is being commissioned to lead the work and will take account of current thinking on how benefits and harms can best be presented so as to promote informed choice.

      The current leaflet was last revised as recently as December 2010 after criticism in the BMJ (2009;338:b86, doi:10.1136/bmj.b86) and in the letter to the Times on 19 February 2009 by 23 signatories, led by Michael Baum, professor emeritus of surgery at University College London, and including Susan Bewley, professor of complex obstetrics at King’s College London. Professor Richards’s new undertakings are published in response to an open letter from Professor Bewley, also published today by the BMJ (2011;343:d6894, doi:10.1136/bmj.d6843). In it she says that she is not convinced that Professor Richards has challenged his experts “competently and mercilessly, rather than hidden behind them.”

      The row over breast cancer screening relies principally on studies by Peter Gøtzsche and colleagues from the Nordic Cochrane Centre. They say that the leaflet exaggerates the benefits and fails to give due weight to the harms, including that of being treated unnecessarily.

      Although the latest leaflet says that one death from breast cancer is prevented for every 400 women screened for 10 years, the Nordic team says that the number needed to screen is 2000. At the same time, 10 healthy women will become cancer patients and will be treated unnecessarily and about 200 healthy women will experience a false alarm. The leaflet does refer to the risk of needless treatment but does not attempt to quantify it.

      It records that a quarter of women found to have breast cancer will have the early form, ductal carcinoma in situ, and adds, “We don’t know which cases of DCIS become harmful so we offer these women treatment.”

      Dr Gøetzsche also contests the claim made in the leaflet that 1400 lives are saved every year in England by screening. In her open letter Professor Bewley says that this number has not been subjected to proper scrutiny and that when she raised the issue privately with Professor Richards he said that a large majority of UK experts disagreed with the methods used by the Cochrane group. “Inadequate and unpersuasive,” says Professor Bewley of Professor Richards’s response.

      Professor Richards has gone some way towards meeting the critics’ demands by saying that an independent group will rewrite the leaflets, rather than those involved in the programme, who are charged by critics with having a conflict of interest.

      The review of the evidence will be led by Professor Richards and Harpal Kumar, chief executive of Cancer Research UK. Independent advisers who have never published on breast screening are being sought.

      Notes

      Cite this as: BMJ 2011;343:d6905

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