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NHS breast screening report contradicts Cochrane findings

Andrew Moscrop BMJ

The NHS Cancer Screening Programmes insisted this week that breast screening saved lives, despite recent claims to the contrary by the Cochrane centre.

Julietta Patnick, national coordinator of the NHS Cancer Screening Programmes, said that breast cancer screening "reduces the risk of a woman dying from the disease." This statement contradicts the findings of a Cochrane review published last month. The Cochrane review concluded that "currently available reliable evidence does not show a survival benefit of mass screening for breast cancer (and the evidence is inconclusive for breast cancer mortality)." The abstract of the Cochrane review can be accessed at www.cochrane.org/cochrane/revabstr/ab001877.htm

The 2001 breast screening programme's annual review, published this week, said that "more women are being screened and more cancers are being detected than ever before" and that this "should help to improve women’s chances of survival."

No-one at the launch of the review raised the findings of the Cochrane Review, but after the launch Mrs Patnick said that research published in the BMJ last year suggested that breast screening was effective, contrary to the claims of the Cochrane Review. This research showed that between 1990 and 1998 breast cancer mortality fell by 21.3% in women aged 55-69. Of this fall, 6.4% was attributed to screening (2000;321:665-9).

The annual review said: "It has been a successful year for the breast screening programme." Statistics for 2000-1 show that the number of cancers detected rose to over 9000 for the first time since the programme began in 1988.

The review also showed an increase in the number of women screened and attributes this to "the expected increase in the numbers of women in the target group." The proportion of women accepting invitations for screening is the same as last year’s figure of 75%. The review stated that the screening programme had "now reached a relatively ‘steady state’ with the major changes coming from changes within the population."

Accompanying the publication of the breast screening review, the NHS Cancer Screening Programmes has this week launched the "Informed Choice" initiative. This aims to provide women with "honest, clear and balanced information about the benefits and limitations of breast and cervical screening."

The initiative will meet the NHS Cancer Plan's commitment to providing all women with an information leaflet along with their invitation to attend screening sessions. The leaflets will be translated into five languages and will be produced in Braille and on audiotape. They will inform women about the practicalities of screening tests and will explain about false positives and false negatives.

"There are no guarantees that screening is 100% effective, and this is what women need to understand when deciding to attend. We are providing women with honest and accurate information to help them in this decision," said Ms Patnick. (See p 1131.)

Breast Screening Programme Annual Review 2001 is available at www.cancerscreening.nhs.uk/breastscreen/publications/2001review.html.
 
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