BBC News HEALTH New concerns over mammogram

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> BBC News | HEALTH | New concerns over breast screeningBBC News

> HEALTH New concerns over breast screening.htm

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> - http://news.bbc.co.uk/hi/english/health/newsid_1607000/1607113.stm -

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> New concerns over breast screening

> Spotting cancers: But do mammograms save lives?

>

> A fresh row has broken out over controversial claims that screening for

> breast cancer may not actually be saving lives.

> The research was first published last year, but has been re-examined

> following a series of protests from cancer organisations over the

findings.

> Now one of the world's leading medical journals, The Lancet, agrees that

> there is not enough evidence from large-scale trials to support breast

> screening.

> However, cancer charities and the UK cancer screening programme disagree

> strongly with their verdict.

> At present, there is no reliable evidence from large randomised trials to

> support screening mammography programmes

>

> Richard Horton, Editor, The Lancet

> All UK women aged between 50 and 64 are currently offered screening once

> every three years.

> It is hoped that tumours may be spotted earlier, making treatment more

> likely to provide a cure.

> Currently, it is reckoned that as many as 300 lives are saved a year by

> breast screening - and more recent estimates suggest this annual figure is

> climbing rapidly.

> However, two Danish researchers from the Nordic Cochrane Centre in

> Copenhagen have re-examined the seven large-scale studies looking into the

> effectiveness of breast screening.

> They say that the studies which support breast screening are either flawed

> or weak, with the only two high quality studies showing no benefit at all.

> In addition, they suggest that screening may result in women receiving

more

> aggressive treatments for cancer, increasing the number of mastectomies by

> approximately 20%.

> They write, in The Lancet: " We hope that women, clinicians and

policy-makers

> will consider these findings carefully when they decide whether or not to

> attend, or support screening programmes. "

> Flood of criticism

> The Danish pair, Peter Gøtzsche and Ole Olsen, first voiced these

criticisms

> last year, and provoked a flood of protest as a result.

> In the light of this, they say, they have thoroughly reviewed their work -

> and reached the same conclusion.

> " We found the results confirmed and strengthened our original conclusion, "

> they wrote.

> However, cancer organisations in the UK have repeated their attacks on the

> conclusions.

>

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> We found the results confirmed and strengthened our original conclusion

>

> Peter Gøtzsche and Ole Olsen, report authors

> Many are worried that any adverse publicity about breast screening will

> dissuade women from coming forward.

> Stephen Duffy, an expert in breast screening from the Imperial Cancer

> Research Fund, said that the five studies which supported the use of

> mammograms should not have been excluded.

> He said: " Studies in the UK and Sweden by ICRF and others have shown

breast

> cancer screening substantially reduces women's risk of dying of breast

> cancer.

> " Research published only in May demonstrated that women who attend regular

> breast screenings may reduce their risk of dying by more than 50%. "

> Disagreements

> A spokesman for the UK Breast Screening Programme agreed: " The way

Gøtzsche

> and Olsen classified studies was based on criteria that would not be

agreed

> by many experts in the field.

>

>

> Studies in the UK and Sweden by ICRF and others have shown breast cancer

> screening substantially reduces women's risk of dying of breast cancer

>

> Stephen Duffy, Imperial Cancer Research Fund

> " Indeed many researchers would classify all seven studies as of similar

> quality, and when the results from all seven studies are combined, there

is

> clear evidence of the benefit from mammography. "

> If existing studies are too weak to support the use of breast screening,

> then the chances of organising large-scale replacements are slim, as these

> would have to involve a sizeable " control " sample who would not be

screened

> for the purposes of comparison.

> As most clinicians already feel that breast screening offers a significant

> benefit, it would probably be felt ethically unsound to leave so many

women

> without it.

> However, the fact that The Lancet now backs the Danish team is a

significant

> move in supporting those who question the benefits of breast screening.

> Editor Richard Horton wrote: " Women should expect doctors to secure the

best

> evidence about the value of screening mammography.

> " At present, there is no reliable evidence from large randomised trials to

> support screening mammography programmes. "

> Professor Michael Baum, from the Portland Hospital in London, says that it

> is now right that women should be presented with all the evidence about

> screening before they give their consent.

> He said: " Even with the most optimistic estimates on saving lives, you

would

> still have to screen 1,000 women for 10 years to save one life.

> " If you have one significant adverse event which costs a life in this

group

> over this period, all that benefit is cancelled out.

> " The Lancet is a highly influential journal and if they are backing this

> review, it's highly significant. " WATCH/LISTEN

>

> ON THIS STORY

>

> The BBC's Karen Allen

> " The scientists are being backed by one of the most respected medical

> journals "

> Cancer surgeon Professor Michael Baum

> " The statistics have to be taken very seriously "

> On the BBC's Today programme:

> Ole Olsa, one of the authors of the report, and Julietta Patnick of the

NHS

> screening programme

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