Questions about how best to communicate to the public about the tradeoffs of potential benefits versus potential harms of mammography do not end at America’s shores.
An independent investigation into breast cancer screening has been set up by the government’s cancer chief to try to settle the growing controversy around its usefulness and potential harms.
Prof Sir Mike Richards’s move is an attempt to put to rest the criticisms of a number of scientists, who say the NHS (British National Health Service) screening programme wrongly identifies cancers that might never harm women, leading to unnecessary and potentially damaging treatment with surgery, drugs and radiation therapy.
They also contest the official NHS position, which is that although there is some over-treatment as a result of screening, mammograms save lives.
The BMJ today published a letter from Susan Bewley, professor of complex obstetrics, Division of Women’s Health, King’s College London, to the man BMJ calls “England’s cancer tsar,” Mike Richards. Excerpt of her letter:
“I declined screening when it was offered, as the NHS breast screening programme was not telling the whole truth. As a non-expert in the subject, I found myself examining the evidence for breast screening with increasing doubts. I compared the NHS and Nordic Cochrane Centre leaflets and found that the NHS leaflets exaggerated benefits and did not spell out the risks. Journals showed a reputable and growing body of international opinion acknowledging that breast cancer screening was not as good as used to be thought. The distress of overdiagnosis and decision making when finding lesions that might (or might not) be cancer that might (or might not) require mutilating surgery is increasingly being exposed. The oft repeated statement that “1400 lives a year are saved” has not been subjected to proper scrutiny. Even cancer charities use lower estimates. I expressed my misgivings to you “behind the scenes” as a work colleague. You replied in a personal email “that the large majority of experts in this country disagrees with the methodology used in the Cochrane Centre reviews of breast screening.”
It is extraordinary to be told that methodology is contentious so many years into the national programme.”
And the BMJ published Richards’ response. Excerpt:
“I take the current controversy very seriously. I will do my best to achieve consensus on the evidence, though I realise this may not ultimately be possible. Should the independent review conclude that the balance of harms outweighs the benefits of breast screening, I will have no hesitation in referring the findings to the UK National Screening Committee and then ministers. You also have my assurance that I am fully committed to the public being given information in a format that they find acceptable and understandable and that enables them to make truly informed choices.”