LONDON — 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 has argued 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, 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 both 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 at some point in their lives. The country’s 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 percent in 2007 from 41 percent in 1971, according to CRUK.
The conclusions of the review are based on analysis of 11 trials that all 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, not least because of their age, 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 percent less than those who are not invited.
Harpal Kumar said research is under way that could lead to more sophisticated tests that 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 who have had something unusual picked up through screening to seek full advice and discuss all possible options with their breast cancer specialist team,” he said.
Ladies, pay no attention to this. GET SCREENED. There are many imaging options beyond mammography with is the basic tool. Feel free to get second opinions, especially if surgery is involved. Talk to friends, neighbors and relatives who have survived cancer. The less harmful cancers in this study were removed before we know what might have happened.
Without screening, there is little chance of finding ANY cancer before it is too late. This is not just about cosmetics, this about living. I had a good friend die of breast cancer when her daughter was only 3 years old. She was only 32. Lets not take chances with our lives or our families.
To advise women to ignore the article, rather than to more closely examine the value and effects of various types of screening, the role of fear, the value in knowing our bodies, the lack of nationally-standardized protocols for assessment, imaging, and medical protocols, is unhelpful. Misdiagnosis has devasting effects. Mammography,(often repeated), along with other tests, come with their own risks.
We must not be breast cancer phobic. Maintaining that level of fear and anxiety places undue stress on our minds and bodies, causing imbalance, reducing immune response, increasing the probability of dis-ease, even if but a headache.
Women who choose to be screened should do so based on reason. Personnel involved and equipment used should be of high quality. Self-breast exam should be practiced, and approached with the attitude that we should know our bodies, not as a “hunt.”
I think the study is, frankly, quite devoid of any useful findings. http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/what-the-breast-screening-review-means and reads as poorly as U.S. cancer-realted sites.
You know, there are studies which show that women who die in advanced age and who have autopsies have malignancies found that did not cause their demise. At the very least, we must eliminate fear, (and profit motives), from the equation.
Loss to this disease, or any other, is horrible, but let us not chastise women who choose not to participate in “regular screening.”
Your advice encouraging second opinions, (or 3rd and 4th opinions), is appreciated.
Please don’t take the advice of this article. Get screened every year if you are over 50.
The article gives no advice. In fact, the interpretation given in the article, that, “The panel …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 percent less than those who are not invited.” Although that does translate to mean that women who are not “invited” for screening, have an 80% higher risk of dying from breast cancer.
It is not for me to dictate what women should do regarding screening, nor should anyone else. Let the individual, thoroughly informed, make decisions she believes are in her best interest.
A more meaningful statistic would be the ratio of correct diagnoses to false positives. After all, correct diagnoses should lead to less deaths, or at least prolong the survival period. It isn’t just about fatalities. The other comments are correct. Pursue all options and tests before operation.