“Citizens’ jury” disagrees over whether screening leaflet should put reassurance before accuracy

BMJ 2012; 345 doi: (Published 26 November 2012) Cite this as: BMJ 2012;345:e8047

Re: “Citizens’ jury” disagrees over whether screening leaflet should put reassurance before accuracy

The Marmot review 'found that women invited to mammographic screening were 3 times as likely to be 'overdiagnosed' as they were to have their lives saved’, but in the citizens’ jury 'there was agreement that the leaflet should begin by citing the numbers of lives saved by breast cancer screening, 1300 a year according to the Marmot review, followed by the caveat that a small number of women would suffer overtreatment after the diagnosis'. 4000 women is a small number?

‘Only three participants had opted for reassurance rather than accuracy’...yet it seems reassurance and encouragement to screening will once again be the message in the new leaflets. Women have come to rely on breast screening as a prop. Those who have survived are convinced it saved their lives – because for years they have not been told the truth and do not realise that improvements in treatment were responsible.

I’d like the new information to really tell the truth about breast screening: that finding early changes will not save lives or change the time of death, but only make women cancer patients for longer, and many of them unnecessarily; that if they consent to screening they are far more likely to be harmed than helped, far more likely to become a cancer patient than if they declined.1, 2 I’d also like it to state that, according to the Department of Health (phone call, 26 November 2012), GPs - who are signposted in screening information as screening ‘advisors’ to help women decide whether or not acceptance of screening is the right decision for them - may well be paid to encourage women to participate in breast screening (as well as other interventions) if their Health Authority deems recruitment to be getting too low for viability.

So much for openness and honesty in healthcare.

1 Bleyer A, Welch HG. Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence. N Engl J Med 367;21.

2 Cancer Survivor or Victim of Overdiagnosis? H Gilbert Welch. The New York Times. 21 November 2012.

Competing interests: No competing interests

28 November 2012
Mitzi AJ Blennerhassett
medical writer, patient advocate
Rarer Cancer Forum