3 days popular7 days popular1 month popular3 months popular

Cancer Expert Remains To Be Convinced By Breast Screening Review

In this week’s BMJ, a leading says he remains to be convinced that the benefits of breast screening outweigh the harms.

, Professor emeritus of surgery at University College London says that, while deaths from may be avoided, any benefit will be more than outweighed by deaths due to the long term adverse effects of treatment.

He estimates that, for every 10, invited for screening, three to four are avoided at the cost of 2.72 to 9.25 deaths from the long term toxicity of radiotherapy.

These figures contrast with an independent report on breast cancer screening, led by and published in November last year. Marmot and his committee were charged with asking whether the screening programme should continue, and if so, what women should be told about the risks of overdiagnosis.

They concluded that screening should continue because it prevented 43 deaths from breast cancer for every 10,000 women invited for screening.

The downside was an estimated 19% rate of overdiagnosis: 129 of the 681 cancers detected in those 10,000 women would have done them no harm during their lifetime. However, those women would have undergone unnecessary treatment, including surgery, radiotherapy and chemotherapy.

But despite this higher than previous estimate of overdiagnosis, they concluded that the breast screening programme should continue.

The report also judged that screening reduces the risk of dying from breast cancer by 20%. But Professor Baum disputes these figures, saying the analysis takes no account of improvements in treatment since these trials were done, which will reduce the benefits of screening. Nor does it make use of more recent observational data.

With these data included, estimated rates of overdiagnosis as a result of screening increase to up to 50%, he argues.

This is important because it can change the decisions women make when invited for screening. In a study also published today, researchers at the University of Sydney explored attitudes to screening in a sample of 50 women. Many of the women were surprised when they were told about overdiagnosis and most said they would attend screening if overdiagnosis rates were 30% or lower, but a rate of 50% made most of them reconsider.

An accompanying editorial points out that the harms of screening will reduce as more effective diagnostic  processes develop to inform less harmful and more personalised treatments. In the meantime, it says women need up to date and transparent information about the benefits and harms of screening to help them make informed choices.


“Personal View: Harms from breast cancer screening outweigh benefits if death caused by treatment is included”, Michael Baum et al.
BMJ 2013;346:f385 doi: 10.1136/bmj.f385

“Women’s views on overdiagnosis in breast cancer screening: a qualitative study”, Jolyn Hersch et al.
BMJ 2013;346:f158 doi: 10.1136/bmj.f158

Editorial: “Breast cancer screening: what does the future hold?”Cliona C Kirwan.
BMJ 2013;346:f87 doi: 10.1136/bmj.f87