• From the ED: Breast Cancer Mammograms: Overrated – and Over-diagnosing Women

    Posted on June 23, 2014
    by Caitlin C.
    Posted at:  Breast Cancer Action

    Editor’s Note: You may have seen Karuna’s article back in April of this year when it was published in The Guardian. The piece generated a lot of discussion – over 1,000 people shared it on their Facebook page and over 150 people commented on the article itself. Many of you who have been through several iterations of these debates are used to the controversy that arises from publicly challenging routine mammography screening. What’s new this time around is the growing agreement that the benefits of routine mammography screening have long been overstated, and the harms long underestimated. Ten years ago, our challenge to the conventional position that “early detection saves lives” and “early detection is your best protection” was highly unpopular. Our independent position was a hard truth for many to hear even though it was grounded in evidence because it went against the grain of pretty much every mainstream breast cancer organization—many of which were and still are heavily invested (both in terms of funders and core values) in the “early detection saves lives” philosophy. We’ve reached a tipping point recently and now increasingly we hear more discussion about this issue and less unquestioned acceptance of the earlier screening messages.Karuna-Jaggar-headshot-2014-150x150

    By Karuna Jaggar, Executive Director

    How will we ever hope to make desperately needed progress in the breast cancer epidemic when the mainstream breast cancer movement continues to push an outdated and scientifically debunked agenda? The evidence has been mounting that the time has come to radically re-think the tenets of the breast cancer awareness movement because it is clear that the fundamental philosophy behind “early detection” is flawed. [Read More…]

  • Breast Cancer Screening Does Not Reduce Deaths Says Study Of 40 Years Of Mammograms

    Article Date: 11 Jun 2013 – 9:00 PDT

    Posted at: MedicalNewsToday.com

    A new UK study suggests screening for breast cancer does not reduce deaths from the disease. The study, which looked at nearly 40 years of breast screening, adds to the controversy surrounding whether it is screening or improvement in treatment that accounts for the fall in rates of death from breast cancer.

    The researchers from the Department of Public Health at the University of Oxford, report their findings online in the June issue of the Journal of the Royal Society of Medicine.

    For their study, lead author Toqir Mukhtar and colleagues analyzed mortality statistics recorded before and after 1988, the year that the National Health Service Breast Screening Programme began.
    [Read More…]

  • NHS Breast Screen Program Does Not Give Women Informed Choice, It Misinforms The Public, UK

    Academic Journal
    Main Category: Breast Cancer
    Article Date: 04 Sep 2011 – 9:00 PDT

    Peter C Gøtzsche and Karsten Juhl Jørgensen of the Nordic Cochrane Centre urge for “more honesty” from the NHS BSP (Breast Screening Programme). They believe that harm has been understated, and that information issued to the public has in general been unaffected by “repeated criticism and pivotal research” which has expressed reservations regarding screening benefits and registered considerable over-diagnosis.

    Their paper, “The Breast Screening Programme and Misinforming the Public”, is published in the Journal of the Royal Society of Medicine.

    The authors say:
    “Spokespeople for the Program have stuck to the beliefs about benefit that prevailed 25 years ago and continue to question the issue of over-diagnosis.

    Women therefore cannot make an informed choice whether to participate in screening based on the information the Program provides. This must be changed.”

    The report explains that information is largely embellished, regarding the lives that have been saved through the screening program.

    Professor Peter Gøtzsche, co-author of the paper and Director of the Nordic Cochrane Center, explains:
    “The claim that death rates have fallen ‘in part from earlier diagnosis associated with screening’ is astonishingly misleading.

    Deaths from breast cancer are falling because treatment is improving. There’s been a similar fall in the age-groups not invited to screening. In this respect, and many others, the Program persists in misinforming the public. It was forced to revise its leaflet inviting women for mammography but the new leaflet and their latest Annual Review continue to repeat incorrect mortality estimates.”

    The program estimates that one breast cancer death for every 400 women is prevented by being screened on a regular basis over a ten year period – arguing against this the authors say:
    “(the figure) is wrong by a factor of five. We have been unable to find any evidence for this estimate in reports from the Program or elsewhere. The 1993 meta-analysis of the Swedish trials reported that one breast cancer death was avoided for every 1000 invited women after ten years. The number is 2000 if we use the more realistic estimates of a 15% reduction in breast cancer mortality.”

    They also stress that contradictory information about over-diagnosis is being provided by the NHS BSP.
    “The (2010) Review has reverted to repeating the much too low estimate regarding over-diagnosis from the 2006 Review, but it is obscure as to where this figure comes from. The new leaflet never uses the term over-diagnosis, and although it talks a lot about ‘benefits’ it does not use the equivalent term ‘harms’ but just speaks about ‘downsides’, which is far less negative.”

    In the report they explain that “the only hint at over-diagnosis” in the invitation leaflet is the sentence ‘Screening can find cancers which are treated but which may not otherwise have been found during your lifetime’. They believed this is vague and readers may understand that screening can only be good, as it detects cancers which would otherwise be hard to find.

    The researchers tried out the sentence on a group of fourth year medical students – by this time in their training they still would now have had lectures about screening. They discovered almost half did not understand the sentence and one third believed it was bad for women to have these cancers detected.

    The researchers said:
    “There is no quantification of over-diagnosis in the leaflet and no estimate of the balance between benefit and harm.”

    The Programs 2010 Annual Review was criticized by the authors for using sentences, such as..:
    “If a breast cancer is found early, you are less likely
    to have a mastectomy.”

    ..claiming that the program encouraged belief that screening will reduce the chances of the women needing to have a mastectomy. The authors express:
    “But such claims are seriously misleading. Danish data has demonstrated that because of over-diagnosis, screening increases the use of mastectomies substantially.”

    Written by Grace Rattue