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Original article at http://www.dailymail.co.uk/femail/article-2037532/Does-breast-cancer-screening-harm-good.html

 

Does breast cancer screening do more harm than good?

Mammograms save countless lives. So why are a growing number of doctors claiming they lead to needless surgery – and misery?

By Isla Whitcroft
Updated: 09:32 GMT, 15 September 2011

 

The card inviting Margaret Corrie for her first mammogram arrived just a few weeks before her 50th birthday.

She popped along to a mobile breast screening unit and went away convinced she would hear nothing more.

But, two weeks later, doctors explained they had found what looked like a cancerous abnormality. It transpired that Margaret had a 1cm Grade 2 lobular cancer (meaning it hadn’t spread to surrounding areas) and the surgeon recommended a full mastectomy, which was carried out with a reconstruction in July. She also had to go through ten months of chemotherapy.

But, despite it all being a terrible ordeal, Margaret is now fully recovered, and credits the screening with saving her life.

Another tremendous success, then, for the breast-screening programme that was introduced across the UK in 1988.

Today, around 1.5 million women, mostly between the ages of 50 and 70, are screened in the UK each year and the programme, it is claimed, saves the lives of around 1,300 women annually.

The perceived wisdom is that breast-cancer screening is a no brainer. If you have cancer, any cancer, surely it’s best to catch it as early as possible so that it can be more effectively treated and you have the highest chance of survival. The annual cost of around  £100 million to run the programme seems like money well spent.

Unfortunately, there is a growing body of respected medical and research opinion which shows things are simply not that clear cut.

Last week, a paper published in the Journal of the Royal Society of Medicine reiterated the conclusion that, far from being of huge benefit to women, breast-cancer screening may, in fact, be doing nearly as much harm as it does good.

‘I can understand why people find this hard to believe,’ says Dr Karsten Jorgensen, a research scientist with the independent Nordic Cochrane Centre in Denmark, who has carried out in-depth research into the harms and benefits of breast screening.

By comparing survival rates from an area of Denmark that has had no screening against areas that have, the Cochrane Centre found that far from the NHS claim that screening saves the lives of 1,347 lives each year, the true figure is more like 500. This means that for every life saved, 2,000 women have to be screened.

Furthermore, Dr Jorgensen and his team claim that of those women screened, around one in four will receive an incorrect diagnosis — a false positive — during her screening lifetime.

This is when a woman will be told their mammogram has thrown up something suspicious that will need further investigation, such as a biopsy, only to be told later there is no cancer.

Even worse, he says, thousands of women in the UK are being over-diagnosed each year — that is, they are being treated for cancers which they simply do not have.

These figures are backed up by Australian research published in 2010, which found that one in three of all invasive cancers diagnosed by screening falls into this category.

This means that every year in the UK up to 7,000 women receive unnecessary surgery, plus possible chemotherapy and radiotherapy, with all the long-term health risks such as lymphoma, infections and stroke for a cancer which may never have existed.

Unsurprisingly, the findings by medical bodies around the world that challenge the benefits of screening have created a furious debate in the medical and scientific community. ‘These same criticisms have been trotted out a number of times by the same authors,’ says Professor Julietta Patnick, director of the NHS Cancer Screening Programme.

‘On each occasion, they have been comprehensively rebutted in the public domain by various experts.

‘The most recent estimates suggest that screening saves one life for about 400 women screened over a ten-year period. We know that 97 per cent of women with screen-detected cancers are alive five years later compared to just over 80 per cent of all women who were diagnosed without screening, and attending a screening lowers a woman’s risk of having a mastectomy.’

Dr Trish Groves, deputy editor of the British Medical Journal, a publication which has led the debate on breast screening, doesn’t entirely agree.

‘There are two main issues when we look at breast screening,’ she explains. ‘The first is false positives, when a woman may be told the scan has picked up abnormalities and then is sent for various checks and scans and needle biopsies — even a lumpectomy — only to be told she is clear.

‘The other issue is over-diagnosis and therefore over-treatment. We know around 20 per cent of cases diagnosed by screening are Ductal Carcinoma in Situ (DCIS).’ (DCIS is a very early form of breast cancer. Cells inside some of the breast ducts have begun to turn cancerous, but have not yet spread into surrounding breast tissue.)

She adds: ‘DCIS can only be picked up by mammogram and so is relatively new to us. We know little about how it spreads and grows, although initial research suggests around 50 per cent of this type of cell changes will never spread and are not actually cancerous. 

‘But, by and large, DCIS is treated in the same way as all other breast cancers — with surgery, sometimes a lumpectomy but occasionally a mastectomy, maybe even chemotherapy. Although some women may be happy to have a complete regime of treatment for a condition which may not be cancerous, most will not.

‘Either way, we have to accept that screening means that a large number of women will undergo a life-changing, painful, nasty treatment regime when, in fact, there is nothing wrong with them at all.

‘We believe that the leaflets for the NHS Breast Screening Programme don’t really explain the potential harm and instead overstate the benefits of screening, rather than offering mammography to women whose symptoms, family histories or genetic make-up suggests they’re at risk of breast cancer, and the harms aren’t really explained at all. We think that should change.

‘Doctors, the public, politicians and, of course, women and their families, might still think that saving one life is well worth the downside of screening thousands of women and giving hundreds of them unnecessary treatments, but shouldn’t they at least be told that the benefits aren’t certain?’

This is a scenario that motivational consultant Jessica Richards knows only too well.

The 54-year-old from Bedfordshire was diagnosed in 2007 with a 2.5cm Grade 2 ductal cancer after she noticed a change in a long-standing lump in her left breast.

‘Five years before I had a scan of the same breast and I was told the lump was benign,’ she says. ‘This time the mammogram said it was abnormal.

‘After a biopsy, the cancer was graded as invasive and there were cancer cells in one lymph node, a micro amount in another and my blood tests came back as normal. I was advised to have a mastectomy, followed by chemotherapy and a five-year programme of drug therapy as soon as possible.’

Jessica adds: ‘Rather than rush into anything, I took a step back. I spoke to doctors and radiologists, alternative therapists, went online and read a lot.

‘I knew I didn’t tolerate medicines well and felt chemotherapy would be disastrous. My blood tests kept coming back normal and I decided I would not go it alone with conventional treatment, but would have regular ultrasound scans and tests.’

A fan of alternative therapy, Jessica also took large amounts of vitamin C intravenously and altered her diet. Within a few weeks the lump had softened and began to break down.

Five years on, the lump is a tiny hard pip, she is fit and well, and has written a book, The Tropic Of Cancer, to share her experiences and knowledge.

‘My doctors were always very supportive of my decision, but there was no disguising the fact that once a mammogram picks up an abnormality you go into a system that processes you with little thought about you as an individual,’ says Jessica.

‘You could say that having a mammogram saved my life, or you could say that it could have pushed me into having needless treatment. Either way, I won’t be having one again.’

While Jessica’s alternative treatment may have worked for her, it is unproven and not one that any doctor or clinician would recommend. However, there is no doubt her story highlights the fact that women should not be afraid to question their mammogram diagnosis.

Dr Emma Pennery, clinical director of the charity Breast Cancer Care, says: ‘What is important is that women are properly informed about the risks of the screening programme as well as the benefits. For example, receiving a false positive may be a completely acceptable risk to one woman if she thinks she may have an early detection of cancer. But to another woman this may bring unimaginable strain.

While the arguments rage, oncologists and surgeons believe there are merits to both points of view.

‘I feel it is great pity that the two sides have become so polarised,’ says consultant breast surgeon Mr Rajiv Vashisht, who practises at the Clementine Churchill Hospital and the West Middlesex University Hospital.

He adds: ‘We all want to improve the outlook for breast cancer, and the Cochrane Review and other research has thrown up issues we should all  be debating.

‘Overall, I am in favour of breast screening. It does pick up cancers early, which gives women more choices about treatment.

‘False positives are, of course, an issue. Over-diagnosis is something we all dread, but if the results show a problem, we have to assume the worst and treat our patients accordingly.

‘Watch and wait may be a suitable policy for prostate cancer, but breast cancer has a completely different disease path.

‘Prostate cancer is very slow growing and goes first to the surrounding areas — breast goes first to the lungs, liver and bone, and, once that happens, you are struggling to catch up with it.

‘Anyone who works with breast cancer knows what an awful disease it can be and any weapon we have has to be welcomed.’

So, what now is the best option for a woman offered screening?

‘If you have a high risk of breast cancer — a family or genetic risk — then there is no question but that you should be regularly scanned,’ says Professor Jane Maher, chief medical officer of Macmillan Cancer Support and an oncologist.

‘Other women should make sure they fully understand the risks before screening, and the best source of unbiased information is cancer charity websites.

‘Once you know the risks, decide in advance what you will do if you get a positive result.

‘Remember that with the majority of breast cancers there is no need for immediate action. Go away and think about your options, possibly ask for a second opinion, read up on the different treatments options.’

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See what Dr Mcdougall has to say  at https://www.drmcdougall.com/misc/2013other/news/jolie.htm