A story of harms and regrets about cancer screening – the "other side" we seldom hear

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Amidst the flood of stories that only reflect the benefits of cancer screening, here’s a story from the UK – and the Sunday Times – that delivers the perspective of the harms of screening that we seldom hear. It begins:

Jane Flanders was not aware of the risks involved in being screened for breast cancer when she received her invitation from the National Health Service four years ago.

After being diagnosed with cancer and undergoing extensive surgery, the mother of two now wishes she had not attended. She believes she was the victim of over-diagnosis.

The 56-year-old maths teacher from Basingstoke, Hampshire, was diagnosed with ductal carcinoma in situ, a dormant cancer which was not spreading and may never have caused problems.

Doctors advised her to have radical treatment — including a mastectomy — in case it might spread.

“Screening has caused me considerable and lasting harm. It has certainly not saved or prolonged my life,” she said.

“The reality of this diagnosis has been two wide excisions, one partial mutilation (sorry, mastectomy), one reconstruction, five weeks’ radiotherapy, chronic infection, four bouts of cellulitis (a bacterial infection), several general anaesthetics and more than a year off work.”

Flanders believes it is “outrageous” that the NHS has withheld information on the risks. The government has been forced to rewrite its advice to include warnings about potential harm caused by the screening process.

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Comments (4)

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Louise Gaunt

November 4, 2009 at 3:03 am

The whole issue of screening “overdiagnosis” is very dificult – we still do not know which DCIS is safe to leave and which should come out – to leave something and just monitor it can cause unnecessary anxiety for the patient, plus the risk of repeated biopsy at every future attendance if there has been even the slightest change. As clinicians we are working to what is the currently held belief about treatment – debate is important, as is research to try to identify markers that will give us greater confidence in knowing what to excise and what to leave alone. There are women who feel they have been overtreated – there are also women who have had a succesful outcome, and I feel we need to maintain a degree of balance, to avoid loss of confidence in screening. I would be very sad to see women of screenig age not attending and then presenting with advanced invasive cancers. Screening does have benefits, I agree there is the potential for “overtreatment” but until someone can identify those lesions we can leave alone, I will continue to err on the side of caution, i.e. treatment, for my patients.


November 10, 2009 at 10:38 pm

If a patient has cancer, and it is known that tumors respond to a certain chemotherapy regimen by shrinking, physicians assume patients would choose to take it, if it is offered to them. However, the quality of life and the fact that just because a drug shrinks a tumor doesn’t mean that patients will actually live longer.
There is the cost of caring for patients whose deaths have been lengthened by chemo, but with a poor quality of life. These patients are likely to die in a hospital. Often, these are the most expensive deaths, in terms of human suffering.
Cancer sufferers are taking doses of expensive and potentially toxic treatments that are possibly well in excess of what they need. Emerging evidence, brought out in the Journal of Clinical Oncology, showed that many of the highly expensive “targeted” cancer drugs (Herceptin, Avastin and Rituximab) may be just as effective and produce fewer side effects if taken over shorter periods and in lower doses (JCO, Vol 25, No 25; September 1, 2007: pp. 31e-32).
But pharmaceutical companies seem to be attracted to studies looking at the maximum tolerated dose of any treatments. The study suggested that we make the search for minimum effective doses of these treatments one of the key goals of cancer research. For example, Avastin, used to fight colon and lung cancers, the dose being tested is 15mg per kilogram of body weight, despite other research showing it may work with 3mg per kilogram.
Many oncologists value doing things more than listening to patients and discussing important issues with them. Many oncologists are really chemo-therapists rather than physicians who care for patients with cancer. If they were paid for their thinking skills rather than for selling medications, the use of drugs may fall. Patients and families would receive what they want and need thoughtful discourse and expertise in helping them through some very tough times.
But these measures alone are far from sufficient to change the culture of chemotherapy practice where it is emotionally easier and financially more lucrative to administer more chemotherapy than to have the tough discussions.