Benefits of cancer screening take years to appreciate

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f299 (Published 16 January 2013) Cite this as: BMJ 2013;346:f299

Re: Benefits of cancer screening take years to appreciate

The word `risk` is used indiscriminately by Professor Patnick throughout her editorial [1]: `harms` not at all.

`Risks`* are what individuals decide to take (or not) when they have weighed up potential benefits against potential harms. They can only do that (`personalising` them as they do so) if they have a clear idea of what those harms and benefits are likely to be.

Whichever current assessment of population harms and benefits one uses, the statistics show that thousands of individual women are personally suffering harms because they were led, under-informed, to be screened. They went in ignorance of `the facts`.

It is noticeable that Professor Patnick does not use the word `harm`, thereby avoiding the uncomfortable reality that the NHS Breast Screening Programme that she directs is still knowingly inflicting harm on more individual, under-informed women than it can help – even on highest estimates of potential benefit. Furthermore, for two decades she has strenuously resisted all approaches asking her that women be told the truth [2] so that they could make up their own minds, free also from any organisational persuasion or coercion.

For her to suggest `shelving` benefit until later, is unrealistic wishful thinking. For the present, perhaps she could study CONSORT and think about the difference between the meaning of `harms` and `risks`, particularly how it affects people rather than populations.

* A risk is “the probability of harm taking place. It is not possible to directly compare benefits and risks because one is an outcome while the other is the probability of an outcome.” [3]

[1] Patnick J. Benefits of cancer screening take years to appreciate. BMJ 2013;349:f299

[2] Baum M, McCartney M, Thornton H. et al. Breast cancer screening peril. Negative consequences of the breast screening programme . The Times 19th February 2009. http://www.timesonline.co.uk/tol/comment/letters/article5761650.ece?prin...

[3] Ioannidis JPA, Evans S, Goetzsche PC, O`Neill RT, Altman DG, Schulz K, Moher D, for the CONSORT Group. Better Reporting of Harms in Randomized Trials: An Extension of the CONSORT statement. Annals of Internal Medicine, 2004; 141 (10), 781-788

Competing interests: No competing interests

20 January 2013
Hazel Thornton
Honorary Visiting Fellow, Department of Health Sciences
University of Leicester
@"Saionara". 31 Regent Street, Rowhedge, Colchester, CO5 7EA