"Prevention is so much better than healing because it saves the labour of being sick." Thomas Adams, 1618"Prevention is so much better than healing because it saves the labour of being sick."
Thomas Adams, 1618

Breast Cancer Screening Statement

Breast Cancer Screening Statement

May 9, 2018

iPRI calls for an independent inquiry into the effectiveness of Mammographic Screening for Breast Cancer and supports the review ordered by the Secretary of State for Health and Social Care Health into the recent error made by England’s National Health Service that reportedly excluded 450,000 women from a previously promised mammography.

Breast cancer is the commonest form of cancer in English women although mortality rates have been falling rapidly for at least thirty years. Breast screening aims to reduce the mortality rate from breast cancer by finding breast cancers early. It uses an X-ray test called a mammogram that can spot cancers when they’re too small to see or feel.

Breast Cancer Screening in the United Kingdom started to be rolled out following the recommendations in the Report of Sir Patrick Forest (Forrest P. Breast cancer screening. Report to the Health Ministers of England Wales, Scotland and N Ireland by a working group chaired by Professor Sir Patrick Forrest. HMSO, 1986. [Forrest Report]. It was initially focussed on women aged 50 t0 64 but the age range was subsequently extended.

In England, the National Breast Cancer Screening Programme covers all women registered with a General Practitioner between the ages of 50 and 70. Eligible women receive an invitation letter explaining the programme and the benefits and risks of breast screening. In 2015/2016, it was calculated that 72.5% of eligible women were in compliance with the programme while the target had been set at 70% [Toolkit for GP Practices].

On Wednesday 2ndMay 2018, the Secretary of State for Health and Social Care Health, Jeremy Hunt, announced that since 2009 an estimated 450,000 women had not received their final breast screening invitation in the English breast screening programme. This was attributed to a computer failure and triggered widespread concern. This is being widely covered by the media. Such a failure is of potential Public Health importance.

It is surprising that it took nine years for an error of this magnitude to become evident and it indicates that supervision and monitoring of the NHS breast screening (BSP) programme in England is sub-optimal. It is important that when such an elaborate error is made in the provision of Health Services that immediate steps are made to secure the situation by reassuring the public, limiting its impact on health and urgently moving towards remedying the error. It is a time for clear heads rather than scaremongering and that the public receives a common message from authorities rather than just another enactment of the blame-game. This does not help those directly affected nor does it help public confidence”.

Mr Hunt also added that between 135 and 270 women may have “had their lives shortened as a result” of the error. These numbers are estimates and of an uncertain security. But, more worryingly, that phrasing is now being reported as a fact of the number of lives lost, rather than an estimate. It’s not possible to know for sure how accurate this figure may be, but talking about it in this way, before the findings of the independent inquiry into the error has even started, has served to convert concern to fear.

It is the official position of iPRI that there is presently inadequate information available in the public domain to accurately assess the impact of this error on premature mortality from breast cancer in the group of women effected. The Health Secretary is quoted as announcing that it was estimated that between 135 and 270 women may have had their life shortened. A UK National Daily headlined that 270 women have died. Without more detailed information available, it is unclear what the public should believe. The current politicising of the situation is a great disservice to women.

This fiasco is doubly frustrating to those in the scientific community who are not yet convinced that breast cancer screening with mammography effectively reduces mortality. For ten years, publications in leading medical journals like the New England Journal of Medicine, the JAMA and the BMJ have shown that mammography screening has failed to reduce the burden of advanced-stage breast cancers in countries where this screening has been widespread for 20 to 30 years. Decreases in breast cancer mortality observed in most high income countries after 1990 have not been faster and more pronounced in countries where screening was introduced at the end of the 1980s, as compared to countries that introduced mammography screening fifteen to twenty years later.”

The Secretary of State for Health and Social Care Health, Jeremy Hunt, has announced a review of the error. What is urgently needed is an independent, wide ranging review of the effectiveness of Breast Cancer Screening and of the effectiveness of Mammography: many lives depend on this.

 

Peter Boyle and Philippe Autier

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