Controversy grows over value of breast cancer screening
BREAST CANCER screening saves lives, even though it also picks up cases in some women that would never have caused them a problem, according to a review published in The Lancet medical journal.
The independent review, commissioned by the charity Cancer Research UK (CRUK) and Britain’s department of health, follows fierce international debate about the benefits of routine screening and recent research that argues it does more harm than good. “This has become an area of high controversy,” said Sir Mike Richards, the department of health’s national cancer director and one of the sponsors of the review.
Critics of routine screening argue that women can be subjected to unnecessary surgery, radiotherapy and medication to treat cancers that would have posed them no risk.
Harpal Kumar, the chief executive of CRUK, acknowledged the shortcomings of screening but argued that until testing for breast cancer becomes more sophisticated, regular monitoring is the best option.
“Screening remains one of the best ways to spot the very early signs of breast cancer, at a stage when treatment is most likely to be successful,” he said. “Yet, as the review shows, some cancers will be diagnosed and treated that would never have caused any harm.”
A panel of experts led by University College London professor Sir Michael Marmot concluded that screening prevents about 1,300 deaths per year in Britain but can also lead to about 4,000 women having treatment for a condition that would never have troubled them. This means that for every death that is prevented, three women are over-diagnosed.
The review panel called for improved information, in health leaflets for instance, to give women a clearer picture of the benefits and potential harms before they go for a mammogram.
Breast cancer is the most common form of cancer among women in Britain, affecting one in eight. A screening programme invites women aged 50 to 70 for a mammogram every three years and this is being expanded to ages 47 and 73. Earlier diagnosis and better treatments have improved the survival rate to 77 per cent in 2007 from 41 per cent in 1971, according to CRUK.
The conclusions of the review are based on analysis of 11 trials that took place more than 20 years ago, which assessed whether screening resulted in fewer deaths due to the disease, compared to when no screening takes place.
The panel acknowledged the studies had limitations but decided the evidence was strong enough to conclude that women invited for screening have a relative risk of dying from breast cancer that is 20 per cent less than those who are not invited.
Mr Kumar said research is under way that could lead to more sophisticated tests to distinguish aggressive cancers from those that are not. This, coupled with a better understanding of genetic predisposition and lifestyle factors that play a role in breast cancer, could mean more finely targeted screening and less over-diagnosis.
“Until this is possible, we’d recommend women . . . seek full advice and discuss all possible options with their breast cancer specialist team,” he said.