Breast screening "creates cancer patients"?

[Rolfe]

Article from today's paper.

Quote:

The SBCC claims over-diagnosis of cancer is rife and that thousands of women are being denied an informed choice.

Breast screening picks up small pre-cancers called ductal carcinoma in situ (DCIS), some of which will not progress to be a harmful cancer. It is impossible to tell which cancers will become life-threatening and which will not but all women are offered treatment.

The campaigners claim that screening therefore effectively “creates” cancer patients. [....]

“There is a huge debate in the research community about the efficacy of screening – and I do not expect women in the street to understand all the nuances – but they should be made aware there is a debate and by going for screening they may be diagnosed with a cancer that would never manifest itself in their lifetime.”

The leaflet does tell patients that mammograms can find DCIS, but it adds: “We don’t know which cases of DCIS will become harmful so we offer treatment to all these women.”

Interesting dilemma. Something to be considered when discussing apparent increases in the incidence of breast cancer.

Rolfe.

[Ivor the Engineer]

From an individual's perspective I'm not sure it's much of a dilemma.

What are the benefits and risks of treatment?

What are the benefits and risks of delaying treatment?

What are the benefits and risks of non-treatment?

[commandlinegamer]

Would they be happy if cancer were being under-diagnosed?

[Andrew Wiggin]

The same thing happens when you look in the mirror and say 'man that mole looks nasty' and then take it to a doctor, who agrees that it's possibly precancerous and offers to cut it off. The only way to know if it's going to develop into a nasty skin cancer is to wait and see if that's what it does, and by then it's a bit late to say 'if only I'd had it cut off when it was just a tiny nasty looking mole'. Doesn't mean you shouldn't look in the mirror, or that you're in any way worse off.

[Rolfe]

That's true, but it seems to me that women who have DCI identified go through a lot more than is involved in an excision biopsy of a mole. I'm aware of more than one woman who has been severely stressed and gone through a lot as a "breast cancer patient", when the diagnosis was only DCI.

Rolfe.

[23_Tauri]

Originally Posted by Ivor the Engineer

From an individual's perspective I'm not sure it's much of a dilemma.

I think it would be a HUGE dilemma, one of the worst I could think of, TBH.
Treatment of DCIS:
- Removal of all the affected breast tissue, together with an area (margin) of normal breast tissue around it.
- Radiotherapy (with all its concurrent side-effects)
- Hormone therapy such as Tamoxifen (side effects: hot flushes, sweats, increased risk of womb cancer.....)
http://www.macmillan.org.uk/Cancerin...ions/DCIS.aspx

So, possible risk from a DCIS could lead a women to go for treatment resulting in loss of part of her breast, hair falling out, treatment that increases her risk of a different cancer, etc. When she might have never developed cancer anyway.

Originally Posted by Ivor the Engineer

What are the benefits and risks of treatment?

What are the benefits and risks of delaying treatment?

What are the benefits and risks of non-treatment?

Important questions, which would probably be taken on a case-by-case basis.

[EHocking]

Originally Posted by Rolfe

That's true, but it seems to me that women who have DCI identified go through a lot more than is involved in an excision biopsy of a mole. I'm aware of more than one woman who has been severely stressed and gone through a lot as a "breast cancer patient", when the diagnosis was only DCI.

Rolfe.

Considering that most specialists (and the NHS pamphlet AND the SBCC ) admit that they do not know which case of DCI might develop into invasive breast cancer, what is the actual criticism of removing and treating the cancer?

This statement, is an utter misrepresentation of the information in the NHS pamphlet and on their website, as well as what happens in real life.

Quote:

"It is quite unethical for any health professional to persuade a woman to take part in a programme that has known harms without that woman being adequately informed about the harms and making the decision for herself.”

Also, there seems to be a slight consiracy theorist bent to their "information".

From their site;

Quote:

Information disputing the positive effects of screening is more difficult to access – not because this information does not exist, but because present government policy is to promote the screening programme and therefore it is not appropriate for this type of information to be included on a government-funded website.

And I think that their agenda is showing a little further with this comment from the HeraldScotland article,

Quote:

Women today are used to having access to a wide range of information and taking their own healthcare decisions, rather than a “paternalistic” approach, she

Quote:

[Moira Adams, director of the SBCC] said.

It should be noted that the SBCC is merely an advocacy group and not a research group, as evidenced by their approach to lobbying, by this non-scientific approach in 2000,

Quote:

"...we launched a national questionnaire aimed at capturing the views of breast cancer patients and determining where, in the opinion of the patients, government funding needed to be directed.".

...while complaining in the HS article that,

Quote:

"There is a huge debate in the research community about the efficacy of screening – and I do not expect women in the street to understand all the nuances,".

So, it's OK to listen to uninformed women on the subject as long as they agree with the SBCC?


Note that this is what they are NOT, (from their website).

Quote:

We are not a research charity
We are not health professionals

While I fully appreciate that a campaign to better inform patients on issues that may be complex, I think the SBCC are doing more harm than good and disseminating more misinformation than the NHS pamphlet is.

[EHocking]

Originally Posted by 23_Tauri

I think it would be a HUGE dilemma, one of the worst I could think of, TBH.
Treatment of DCIS:
- Removal of all the affected breast tissue, together with an area (margin) of normal breast tissue around it.
- Radiotherapy (with all its concurrent side-effects)

ETA :

In the UK only 30% of patients with DCIS receive radiotherapy, whereas elsewhere in Europe and in the USA it is standard therapy.

(Source : NHS article on management of DCIS below)

Quote:

- Hormone therapy such as Tamoxifen (side effects: hot flushes, sweats, increased risk of womb cancer.....)
http://www.macmillan.org.uk/Cancerin...ions/DCIS.aspx

So, possible risk from a DCIS could lead a women to go for treatment resulting in loss of part of her breast, hair falling out,

Radiotherapy does not cause this, only specific chemotherapy and, like radio, is not an automatic treatment, it is reliant on the type of breast cancer.
As is Tamoxifen and Herceptin treatment, as they work on different hormone receptors.

Quote:

treatment that increases her risk of a different cancer, etc. When she might have never developed cancer anyway.

And despite the agenda driven, non-medical misinformation from the SBCC, the NHS addresses this directly on their site.

Uncertainties in the management of screen-detected ductal carcinoma in situ.

Quote:

Important questions, which would probably be taken on a case-by-case basis.

And are.

Despite the agenda driven, non-medical, misinformation to the contrary from the SBCC.

[casebro]

Same consideration applies to 'body scans' which find inconsequential tumors.

I myself have an "adrenal incidental-oma" found that way. Cute name. No problem, no treatment.

But these kinds of scans can find things that are so small that the chances are they will turn out to be inconsequential.

I would expect that breast cancer surgery would include biopsy, from which a decision could be made as to whether to proceed with radio- or chemo- therapy?

I've also heard that doctors can tell the importance of a lump by feel, about 90% of the time. Of course, it may be that those exact doctors are the ones who want to do the unnecessary surgery?

[Rolfe]

Yeah, I rather thought there was an agenda (not-so-hidden either) in what the SBCC woman was saying.

It's still a bit of a dilemma though. And also may be inflating breast cancer statistics, if things are now being detected that would never have become clinical breast cancer to former diagnostic criteria.

Rolfe.

[Rolfe]

Originally Posted by casebro

I myself have an "adrenal incidental-oma". Cute name. No problem, no treatment.

Not much of a problem if the decision is, no treatment. It's the decision to go for invasive surgical and medical treatment, medicalising these women as "cancer patients", which is the difficult part.

Difficult because some of them actually would have become cancer patients anyway. But some wouldn't.

Rolfe.

[EHocking]

Originally Posted by Rolfe

Yeah, I rather thought there was an agenda (not-so-hidden either) in what the SBCC woman was saying.

A bit of hand-waving on my part too.

It is quite true that the NHS deliverables are not homogenous nation-wide.

Quote:

It's still a bit of a dilemma though. And also may be inflating breast cancer statistics, if things are now being detected that would never have become clinical breast cancer to former diagnostic criteria.

A bit of a quibble really, since former diagnistics were not able to pick these criteria up.

One of the more idiotic arguments on their site is:

Quote:

Breast cancer is a ‘modern’ disease. At the beginning of the 20th century breast cancer was rare.

[EHocking]

Originally Posted by Rolfe

Not much of a problem if the decision is, no treatment. It's the decision to go for invasive surgical and medical treatment, medicalising these women as "cancer patients", which is the difficult part.

Difficult because some of them actually would have become cancer patients anyway. But some wouldn't.

... and even the most experienced of diagnostician can not tell you which way it will go.

So, do you leave it untreated and hope for the best, or do you weigh up the options and treat appropriately?

[Beerina]

I believe there's a similar issue w.r.t. prostate cancer in men and the PSA screening test. In this case, it's real cancer, but it's frequently so slow-growing that it will never be an issue. Even the doctor who developed the PSA test says it's being incorrectly used for screening.

[Rolfe]

Originally Posted by EHocking

... and even the most experienced of diagnostician can not tell you which way it will go.

So, do you leave it untreated and hope for the best, or do you weigh up the options and treat appropriately?

That's the dilemma, I guess. I suppose "wait and see", and then move as soon as it becomes clear this is going to be one of the ones that isn't going to stay dormant, isn't a realistic option, or they'd be doing that.

Originally Posted by Beerina

I believe there's a similar issue w.r.t. prostate cancer in men and the PSA screening test. In this case, it's real cancer, but it's frequently so slow-growing that it will never be an issue. Even the doctor who developed the PSA test says it's being incorrectly used for screening.

Very similar situation, indeed.

I'm a moderate fan of screening programmes, but I do think the potential downside of causing anxiety and medicalising people who may in fact have nothing significant wrong with them is something which has to be factored into any cost-benefit analysis.

The recent bowel cancer screening programme in Scotland did a nice job in explaining the statistics re. how many positives were expected, and how many of these would in fact be false positives, and what would be done to follow people up, and how many lives they actually expected to save at the end of it all.

I have a feeling there may be a problem in breast cancer of reluctance to discuss with women the possibility that they are having some pretty major interventions done, and it might not actually be necessary.

Rolfe.

[Rolfe]

Originally Posted by EHocking

A bit of a quibble really, since former diagnistics were not able to pick these criteria up.

Not really a quibble. Breast cancer prevalence may differ between countries according to the thoroughness of their screening programmes. Breast cancer prevalence may appear to be increasing, leading to people blaming all sorts of irrelevant factors, when in fact nothing has changed.

This issue comes up when people are comaring health statistics between the USA and Euriopean countries, and it's possible that different screening regimens make a true comparison impossible.

Rolfe.

[pgwenthold]

This just goes to illustrate how great imaging is. It is a remarkable thing that we can "see" things like tiny "precancerous growths."

Yes, it is unfortunate that _at the current time_ we are unable to distinguish precancerous growths from things that won't turn into cancer, but that is a great area of research that is going on. And basically, it has to be that way.

1) You have the advances in imaging that allow us to see things we could never see before
2) Because we never could see them before, we have no idea of what they really indicate. Therefore, we treat them all as if they are potentially bad
3) We develop new tools to discriminate between the bad things and the not bad things and only worry about the bad stuff

This is the way it always works, and it is all good.

At the moment, indeed, it is unclear whether it is beneficial to just seek-and-destroy. However, as new procedures develop, we will be able to refine the procedures to gain more insight into which cases need to be treated and which don't.

But you can't get to this point without having the ability to find the beasties in the first place.

[Ivor the Engineer]

Originally Posted by Rolfe

That's the dilemma, I guess. I suppose "wait and see", and then move as soon as it becomes clear this is going to be one of the ones that isn't going to stay dormant, isn't a realistic option, or they'd be doing that.

<snip>

Anyone know if or why this is the case?

[Emet]

Originally Posted by Ivor the Engineer

Anyone know if or why this is the case?

Quote:

DCIS is non-invasive, but without treatment, the abnormal cells could turn into invasive cancer over time. About 20 to 30 percent of women with untreated, low grade DCIS will progress to invasive breast cancer [72]. It is thought that higher grade DCIS are more likely to turn into invasive cancer if left untreated.

http://ww5.komen.org/BreastCancer/Du...omainSitu.html

[JJM 777]

Originally Posted by commandlinegamer

Would they be happy if cancer were being under-diagnosed?

That would look good in the national health statistics.

[blutoski]

Originally Posted by commandlinegamer

Would they be happy if cancer were being under-diagnosed?

Sometimes! It's a math question.

There is a formula for screening tests that shows at what point false positives cause more harm than missed cases. This is why the leaflet is being distributed to women between 50 and 70. Mammograms have more risk than benefit for younger women.

This is true for every screening test from AIDS tests to prostate exams.

So, the SBCC's concerns make sense, but may not apply in this case. The decision to restrict the handouts to 50-70 year old demographic is a reflection of the NHS' awareness of the risk/benefit ratio.

Also: the SBCC's wording is maybe being misreported, perhaps in error. DCIS are not reported as 'cancer' even if they're being 'treated'. Increased identification of precancerous tumours should not lead to any change in cancer diagnosis.

[23_Tauri]

Originally Posted by EHocking

ETA :

In the UK only 30% of patients with DCIS receive radiotherapy, whereas elsewhere in Europe and in the USA it is standard therapy.

(Source : NHS article on management of DCIS below) Radiotherapy does not cause this, only specific chemotherapy and, like radio, is not an automatic treatment, it is reliant on the type of breast cancer.

Thank you for the correction, EHocking. My bad, I should have checked my facts.

Originally Posted by EHocking

As is Tamoxifen and Herceptin treatment, as they work on different hormone receptors.And despite the agenda driven, non-medical misinformation from the SBCC, the NHS addresses this directly on their site.

Uncertainties in the management of screen-detected ductal carcinoma in situ.And are.

Despite the agenda driven, non-medical, misinformation to the contrary from the SBCC.
[/left]

It does seem, with a little wider reading, that the SBCC claims are somewhat alarmist, although soundbites from the OP article in the Herald such as "The SBCC claims over-diagnosis of cancer is rife and that thousands of women are being denied an informed choice" may have more to do with the sensational spin that invariably gets added, to a greater or lesser degree, by hacks.

[EHocking]

What I find disconcerting with the SBCC stance on screening is that it is based on a metastudy that uses 20 year old data.

Screening for breast cancer with mammography (Review)

Screening techniques and tools as well as treatment approach has changed radically in the past 20 years and I think it is less than honest to be declaring that over-diagnosis is rife based on out of date information.

On the subject of DCIS, these are the references;

Quote:

"Screening primarily identifies slow-growing cancers and cell changes that are biologically benign (Doll 1981; Ernster 1996; Fox 1979)."

I looked up the most recent of the papers quoted at Pubmed, the Ernster paper.
It is based on a study of data collected between 1973 and 1992. Basing your arguments on such an outdated paper is dangerous at most and agenda driven misinformation at the least.

The more I read of the Cochrane Reviews papers on breast cancer, the less confidence I have that SBCC are representives of the best source of information on the subject for women.

ETA: NHS Report on breast cancer screening and treatment in 2006.
http://www.cancerscreening.nhs.uk/br...cer-report.pdf

It is these data that the NHS pamphlet is likely to based on. Actual, "current" data, but the SBCC appear to be countering this data with 20 year old data.

[Rolfe]

I don't think they are. I'm still interested to know why it isn't policy to adopt a "wait and see" policy with the DCISs, or just to do an excision biopsy of the lump, histopath on that, and if it has clear margins, then wait and see.

Why is the management of these cases relatively aggressive?

Rolfe.

[EHocking]

Originally Posted by Rolfe

I don't think they are. I'm still interested to know why it isn't policy to adopt a "wait and see" policy with the DCISs, or just to do an excision biopsy of the lump, histopath on that, and if it has clear margins, then wait and see.

Why is the management of these cases relatively aggressive?

If by "excision biopsy" you mean lumpectomy (rather than core biopsy) that's basically what is done, but it is quite common practice to follow up with radiotherapy as you can not be 100% guaranteed that all the margins were captured during surgery.

As the NHS report says,

Quote:

"10% of breast cancers were non-invasive or micro-invasive."

So we're talking about a very small proportion of diagnosed cancers anyway, and

Quote:

"The proportion of non-invasive breast cancers was much higher in women aged 50-70... mainly because 20% of screen-detected cancers were non-invasive compared to only 6% of symptomatic cancers."

So, while

Quote:

"97% of patients with screen-detected breast cancer had a surgical operation compared to 73% of patients with a symptomatic breast cancer.",

"aggressive" surgery is half that for screen-detected breast cancers;

Quote:

"27% of surgically treated patients with a screen-detected breast cancer and 52% with a symptomatic breast cancer had a mastectomy."

As for post-op treatments;

Quote:

"screen-detected cancers were significantly smaller, of lower grade and less likely to be node positive. 59% were in the two best NPI groups compared to 23% of symptomatic cancers." "73% of patients with screen-detected cancer had breast conserving surgery compared to 48% of symptomatic patients,"

BUT,

Quote:

"because their tumours were of a better prognostic type, patients with screen-detected cancer had less chemotherapy (23% compared to 49%."

and

Quote:

"A smaller proportion of patients with screen-detected breast cancer had chemotherapy recorded compared to patients presenting symptomatically (23% compared to 49%)"

All in all, catching it early reduces the "aggressive" post surgery treatment.

While the above are select statements from the report, I don't believe I've misrepresented the data by data mining, I believe they are representative statements of the NHS findings.

[EHocking]

Further explaination of my, well, mistrust of the SBCC's authority on the subject.

From their website,
The argument against screening the entire population:

• X-ray exposure increases the risk of cancer; screening is an x-ray. As yet, there are no statistics available which can determine how many breast cancers are caused by screening.

While raising (possibly) a valid point, the manner in which it is delivered appears to me as unwarranted scaremongering and generating mistrust by the general public of physicians and specialists.

[Puppycow]

Originally Posted by commandlinegamer

Would they be happy if cancer were being under-diagnosed?

Who's the 'they'?

'Over-diagnosed' means that people who don't have cancer or who have benign growths are being unnecessarily diagnosed. The same thing is true with prostate cancer, so there is a similar issue for men.

Personally, I am not getting screened for prostate cancer (at least for the time being) for this reason.

[pgwenthold]

Originally Posted by EHocking

[*]X-ray exposure increases the risk of cancer; screening is an x-ray. As yet, there are no statistics available which can determine how many breast cancers are caused by screening.

Probably because the answer is basically "none."

At least none that have happened that can be directly attributed to screening x-rays. Most of the time, when people get breast cancer, there is no cause that can be assigned (even "family history" only accounts for 30odd% of breast cancers)

However, that doesn't mean that anyone doesn't think [sorry: edited] that screening has contributed to causing breast cancers. And the number of cases that are caused can be estimated based on screening numbers and radiation dosages, and estimates of radiation response, and people absolutely take this into account.

But if you want statistics of how often it has happened, you aren't going to get it.

[EHocking]

Originally Posted by pgwenthold

...However, that doesn't mean that anyone thinks that screening has contributed to causing breast cancers.

Unfortunately, this is not true, as this Google search demonstrates...

http://www.naturalnews.com/010886.html

Since mammographic screening was introduced, the incidence of a form of breast cancer called ductal carcinoma in situ (DCIS) has increased by 328 percent. Two hundred percent of this increase is allegedly due to mammography. In addition to harmful radiation, mammography may also help spread existing cancer cells due to the considerable pressure placed on the woman's breast during the procedure. According to some health practitioners, this compression could cause existing cancer cells to metastasize from the breast tissue.

http://www.cancerhelp.org.uk/type/br...east-screening
Scientists have worked out that there is less than a 1 in 25,000 risk of the radiation from a mammogram causing breast cancer.

http://ezinearticles.com/?Mammograms...cer&id=3543950
The USPS Task Force found that "Radiation-related breast cancers occur at least 10 years after exposure. Radiation from yearly mammograms during ages 40-49 has been estimated to cause one additional breast cancer death per 10,000 women."

[pgwenthold]

Originally Posted by EHocking

Unfortunately, this is not true,

Sorry, typo

I changed it above

What I meant to say is that, yeah, we KNOW screening is contributing to causing breast cancer. No one denies that. It's just that we can't look at any breast cancers and say, "This one was caused by screening." Mainly because we can't look at many breast cancers at all and say, "This one was caused by X"

We can talk about estimates and probability, but there are no statistics that can be given.

[EHocking]

Originally Posted by pgwenthold

Sorry, typo

I changed it above

What I meant to say is that, yeah, we KNOW screening is contributing to causing breast cancer. No one denies that. It's just that we can't look at any breast cancers and say, "This one was caused by screening." Mainly because we can't look at many breast cancers at all and say, "This one was caused by X"

We can talk about estimates and probability, but there are no statistics that can be given.

My objection to the SBCC entry is the manner in which it is baldly placed on their website.

They claim that they are campaigning about reducing stress and worry in women, yet state "X-ray exposure increases the risk of cancer; screening is an x-ray." with absolutely no qualifiers as to what the risk ACTAULLY is, i.e. pretty bloody slim.

It's scaremongering and probably has the detrimental effect of disuading women into having a screening because of an unfounded fear that IT may cause the very cancer they are screening for.

Or at the very least, it further muddies the water for women trying to find good advice on the subject.

[Rolfe]

I don't really have a dog in the fight, I just thought it was an interesting article to spark off a discussion. EH's posts have been very informative.

The one thing I'm still unclear about is why histology of the excision biopsy isn't being mentioned as a decisive factor in determining whether any further intervention is warranted. That's certainly how it would be managed for a skin lump.

Rolfe.

[EHocking]

Originally Posted by Rolfe

I don't really have a dog in the fight, I just thought it was an interesting article to spark off a discussion. EH's posts have been very informative.

The one thing I'm still unclear about is why histology of the excision biopsy isn't being mentioned as a decisive factor in determining whether any further intervention is warranted. That's certainly how it would be managed for a skin lump.

I guess because it is implicit?

The histology is performed on the lump while the surgery (lumpectomy) is being performed. This also determines how to proceed with that surgery and the extent of the surgery, while the surgery is being performed.

Post surgery histology is then used to determine what post-surgery treatment may be efficatious, e.g. radiotherapy, chemotherapy, (which) hormone therapy.

The NHS report notes that there is a percentage of secondary surgery being required, usually due to results of these histologies. The most common being that the DCIS being removed is in fact invasive.
(hand wave - beware generalisations!!)

Note that the figures for surgery quoted above include excision biopsies, i.e., this is what a lumpectomy is (unless I'm getting the nomenclature very, very wrong).

[pgwenthold]

Originally Posted by EHocking

They claim that they are campaigning about reducing stress and worry in women, yet state "X-ray exposure increases the risk of cancer; screening is an x-ray." with absolutely no qualifiers as to what the risk ACTAULLY is, i.e. pretty bloody slim.

And the main reason is an issue is because of the large numbers involved. I mean, suppose there are actually 100 breast cancers each year that ultimately are due to x-ray exposure in screenings. You can either say, "Wow! 100 breast cancers that didn't have to happen!" or you can say, "Let's see, 20 million women got screened last year, and 100 ultimately developed breast cancer. In the meantime, how many cancers were detected early? How much did we gain by catching them early? How many were false positives? How many were missed?"

While it is certainly the case that even slim risks can lead to significant absolute numbers when you apply them to sufficiently large populations, the first statement is fear mongering. You tell people that 100 women got breast cancer from screening x-rays, it sounds bad. You say that the chance of developing breast cancer from screening x-rays is 1 in 200 000, it's not quite the same (especially if you mention the incidence of breast cancer among the general population is like 1 in 10). These are the types of issues that serious people thinking about the issue deal with.

(note: we are agreeing on this, I am just running with your comments)

[EHocking]

Originally Posted by pgwenthold

...(note: we are agreeing on this, I am just running with your comments)

Yes we are.

And so back to the article.

Quote:

"Moira Adams, director of the SBCC, said: “The information contained in the leaflet should come from independent sources and I do not think it should be quite so persuasive.

It is quite unethical for any health professional to persuade a woman to take part in a programme that has known harms without that woman being adequately informed about the harms and making the decision for herself.”

I think it is quite unethical for a campaign group with an agenda to misrepresent the information in the pamphlet in order to support their agenda.

If I'm looking at the correct pamphlet they categorically state that there are risks from radiation from mammography.

"For every 14,000 women screened regularly for 10 years, one woman may develop breast cancer because of the radiation from the mammograms."

And in my opinion this is just malicious,

Quote:

"Ms Adams called for a review of the entire programme to determine how many lives have actually been saved through screening, rather than other improvements in care and medical advances."

They don't refute the claims with any numbers, but with vague, unsupported, scattergun accusations based, if you follow the links on their site, on studies made using 20 year old data - only one of which was based on UK data....

[pgwenthold]

Originally Posted by EHocking

They don't refute the claims with any numbers, but with vague, unsupported, scattergun accusations based, if you follow the links on their site, on studies made using 20 year old data - only one of which was based on UK data....

My take on that comment:

Quote:

"Ms Adams called for a review of the entire programme to determine how many lives have actually been saved through screening, rather than other improvements in care and medical advances."

Why in the heck does she think that this isn't already being done?

Jeez, the US just experienced a huge kefluffle after the mammography recommendations were revised. Regardless of whether anyone personally agrees with the recommendations that came out, doesn't this pretty much show that reviews of the programmes ARE being carried out?

I think she just doesn't like the results of those reviews.

[Tatyana]

Originally Posted by Ivor the Engineer

From an individual's perspective I'm not sure it's much of a dilemma.

What are the benefits and risks of treatment?

What are the benefits and risks of delaying treatment?

What are the benefits and risks of non-treatment?

A few things have been recommended based on evidence based medicine

- screening in women under 50, possibly even 60 is not recommended as the consistency of the breast tissue makes it nearly impossible to detect any tumours.

- there is harm associated with screening which is rarely mentioned in information pamphlets, which more often than not is the unnecessary treatment of harmless lesions that would not have been identified without screening.

Breast screening has not been nearly as successful as cervical screening

- if 2000 women are screened regularly for 10 years, one will benefit from the screening as she will avoid dying from breast cancer

- at the same time, 10 healthy women will, as a consequence, become cancer patients and will be treated unecessarily. These women will have either a part of their breast or the whole breast removed, and they will often receive radiotherapy and sometimes chemotherapy

- screening has resulted in 30% more surgery, 20% more mastectomies and more use of radiotherapy

- furthermore, about 200 healthy women will experience a false alarm. The psychological strain until one knows whether it was cancer, and even afterwards, can be severe.

This is the summary of findings from 6 countries that have publicly funded screening programs (England, Denmark, Iceland, Sweden, Finland and Norway).

^This is from the Feb 21st issue of the British Medical Journal (BMJ vol 338 page 446)

I will find the link for this paper later, I am pretty positive it is 2010, we get the paper copy in the lab, so I read it during tea break.

I think that the issue that the majority of researchers want to emphasis is that there will be false positives, and to prevent the deaths of some women, other women will have to undergo unnecessary treatment.

That there may be this situation has not been explained very well to most women who undergo mammography, and there is a debate at what age it should start at.

I personally think the US starts far too early.

Another good article from the BMJ:

http://www.bmj.com/content/340/bmj.c1824.extract

[EHocking]

Originally Posted by Tatyana

A few things have been recommended based on evidence based medicine

- screening in women under 50, possibly even 60 is not recommended as the consistency of the breast tissue makes it nearly impossible to detect any tumours.

- there is harm associated with screening which is rarely mentioned in information pamphlets, which more often than not is the unnecessary treatment of harmless lesions that would not have been identified without screening.

Breast screening has not been nearly as successful as cervical screening

- if 2000 women are screened regularly for 10 years, one will benefit from the screening as she will avoid dying from breast cancer

- at the same time, 10 healthy women will, as a consequence, become cancer patients and will be treated unecessarily. These women will have either a part of their breast or the whole breast removed, and they will often receive radiotherapy and sometimes chemotherapy

- screening has resulted in 30% more surgery, 20% more mastectomies and more use of radiotherapy

- furthermore, about 200 healthy women will experience a false alarm. The psychological strain until one knows whether it was cancer, and even afterwards, can be severe.

This is the summary of findings from 6 countries that have publicly funded screening programs (England, Denmark, Iceland, Sweden, Finland and Norway).

^This is from the Feb 21st issue of the British Medical Journal (BMJ vol 338 page 446)

I will find the link for this paper later, I am pretty positive it is 2010, we get the paper copy in the lab, so I read it during tea break.

Interesting. The data sets seems to indicate that this is the Cochrane Review metadata report? Basically data over 15 years old, mostly.

I presume the researchers are as annoyed as I am about having to rely on such outdated data (if indeed it a rehash/discussion of the Cochrane paper).

Quote:

I think that the issue that the majority of researchers want to emphasis is that there will be false positives, and to prevent the deaths of some women, other women will have to undergo unnecessary treatment.

That there may be this situation has not been explained very well to most women who undergo mammography, and there is a debate at what age it should start at.

I personally think the US starts far too early.

Another good article from the BMJ:

http://www.bmj.com/content/340/bmj.c1824.extract

It is a very interesting outline of the difficulty in assessing the benefit vs the risk concerning breast cancer screening.

ETA: But back to the OP. Is the SBCC's criticism of the pamphlet adding to the debate or adding to the confusion about the debate.
I don't think that their criticisms of the points covered by the pamphlet is representative of the actual points in the pamphlet.

[Safe-Keeper]

Quote:

The SBCC claims over-diagnosis of cancer is rife and that thousands of women are being denied an informed choice.

[Opposite Land]Yes, that's exactly right, providing a patient with more information is taking away her right to make an informed choice. [/Opposite Land]

[benevolo]

Screening in the US is recommended at age 50, or if someone in the immediate family had breast cancer, it is recommended 10 years prior to that person's onset. There has been lots of high quality research to justify 50 as the cutoff point. Some people even argue you should start at 40 but as mentioned in here, there are way too many false positive results to justify screening younger than 50. However even some studies done in women in their 40s have shown a statistically significant drop in deaths from breast cancer, although this was offset by a very large number of false positive results leading to unnecessary invasive testing.