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How much is too much breast screening?

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h139 (Published 14 January 2015) Cite this as: BMJ 2015;350:h139

Re: How much is too much breast screening?

Torjesen`s article, [1] describing how the government is pushing on with a giant trial of extended breast screening, robustly conveys the outrage that she felt when she discovered that her invitation to attend for screening at age 47 was, in fact, an invitation to participate in a trial. This dismay and outrage is shared by very many women who have also experienced the cavalier approach by the NHS Breast Screening Programme, which flies in the face of good practice. The sleight of hand and dishonesty in their approach to both the running of the study and to the millions of women they invite is breathtakingly arrogant and disrespectful to the citizens they should be serving. That this trial has been given ethics approval and the assent of the government should be questioned and condemned.

Torjesen has set out the details of the history of this travesty of a `trial` – now reclassified “an epidemiological study” to suit the `investigators` intentions – and the ethical reasons for condemning it.

Another important aspect of particular importance is that of waste. A leading letter in a recent edition of The Guardian http://www.theguardian.com/society/2015/jan/09/main-parties-no-longer-tr... signed by seven leading health professionals [2] stated: “We and many others vigorously back this newcomer to electoral politics, which brings these failures into focus: the waste, mismanagement and dishonesty of the major political parties.” The newcomer they refer to is the National Health Action Party. It is to be hoped that the “excellent NHS candidate” in Oxford West and Abingdon that they mention will highlight this particular waste of resources that is wasting millions of pounds on screening an ever widening group of largely unsuspecting women. Robust and reliable evidence from Cochrane shows “that the time has come to re-assess whether universal mammography screening should be recommended for any age group,” because its benefits were “uncertain” and it led to overdiagnosis and unnecessary interventions.” [3] The indirect costs, and of those interventions (financial, physical and emotional), are enormous.

[1] Torjesen I. How much is too much breast screening? BMJ 2015;350:h139

[2] Redman C, Chalmers I, Mcpherson K, Yudkin JS, Ormerod O, Frith P, McCoy D. The main parties can no longer be entrusted with our NHS. The Guardian 9th January 2015. http://www.theguardian.com/society/2015/jan/09/main-parties-no-longer-tr...

[3] Goetzsche P, Jorgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev 2013;6:CD001877

Competing interests: No competing interests

15 January 2015
Hazel Thornton
Honorary Visiting Fellow, Department of Health Sciences
None
University of Leicester
Saionara, 31 Regent Street, Rowhedge, Colchester, CO5 7EA