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Does breast cancer screening present more risks than benefits?

Does breast cancer screening present more risks than benefits?
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An independent investigation into breast cancer screening has been launched by the UK government’s cancer chief, Prof Sir Mike Richards to try to settle the growing controversy around its usefulness and potential harm, writes the Guardian

Prof Richards’ enquiry is a response to the criticism of a number of scientists who say the NHS screening program wrongly identifies cancers that might never harm women, leading to unnecessary and potentially damaging treatment with surgery, drugs and radiation therapy.

Open-letters war

The case started with an open letter from Susan Bewley, professor of complex obstetrics at King’s College London, who had written to Richards with her concerns over routine screening.
She herself had decided not to be screened, even though she had a family history of breast cancer “as the NHS breast screening program was not telling the whole truth”.

“The distress of over-diagnosis 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 ’1,400 lives a year are saved’ has not been subjected to proper scrutiny. Even cancer charities use lower estimates,” she wrote.
In his reply, Richards assured her that he took the current controversy “very seriously” and he listed the evidence that supports screening – including a WHO paper from 2002, which said it reduced deaths in 50- to 69-year-old women by 35%. He said they were seeking independent scientists who had not been involved in the controversy to undertake it and a second independent team was working on an improved screening leaflet that would include both risks and benefits, he said.
“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,” he wrote.

Nordic countries’ screening scepticism

The chief critics of breast cancer screening come from the reputable Cochrane collaboration of scientists, based in Nordic countries. Their studies of the original trials used to support the introduction of screening have been published in leading medical journals including the British Medical Journal.

Most of the large-scale trials of screening were flawed. A well-run major trial in Malmo, Sweden, however, produced results that appeared to show screening saved lives. But in recent years, work by Nordic Cochrane Collaboration authors has disputed the mortality findings. The most recent paper found that many of the early-stage cancers spotted at screening – too small to be detected other than by x-ray – either would not have gone on to cause problems or might even have regressed.

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