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NHS announces major overhaul of national cancer screening programmes in England

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4866 (Published 15 November 2018) Cite this as: BMJ 2018;363:k4866

Rapid Response:

False claims prove the need for independent scrutiny of cancer screening

Despite his eminence, the previous National Cancer Director and Chief Inspector for the Care Quality Commission is the wrong person to lead another review of cancer screening. A previous review was accompanied by his announcement of the Age Extension Trial that has been criticized for being neither scientific nor ethical, and denying the six million women participants the safeguard of explicit informed consent.(1,2,3) Health departments should not mark their own homework with exaggerated claims of success;(4) the latest press release required correction after the Office of Statistics Regulation queried the 100-fold excessive claim that “hundreds of thousands of lives” have been saved(5) – particularly objectionable given that the best evidence shows screening doesn’t show differences in all-cause deaths. Whilst accountable, the National Screening Committee’s expertise should be strengthened. The government must establish trustworthy and independent scrutiny; UK Statistics should independently verify the data and the National Audit Office should examine the value. Meantime, we recommend the general public look this gift-horse in the mouth using great decision aids that are available but not yet shared with them.(6)

(1) Richards M. An independent review is under way BMJ 2011;343:d6843
(2) https://www.newscientist.com/article/dn26529-critics-say-wider-breast-sc...
(3) McCartney M. A trial to extend breast cancer screening may be unethical. BMJ 2014;349:g5105.
(4) https://www.england.nhs.uk/2018/11/cancer-screening-to-be-overhauled-as-... accessed 15th November. Amended 19th November 2018
(5) Jøorgensen KJ, Gøtzsche PC. Who evaluates public health programmes? A review of the NHS Breast Screening Programme J R Soc Med 2010: 103: 14–20. DOI 10.1258/jrsm.2009.090342
(6) Harding Center Fact Boxes for Early Detection of Cancer https://www.harding-center.mpg.de/en/fact-boxes/early-detection-of-cancer with example of icon array at https://www.harding-center.mpg.de/en/system/files/media/pdf/11f9498b276a...

Competing interests: SB and MP are the Chair and Newsletter Editor of Healthwatch-UK, a charity ‘for science and integrity in healthcare’

20 November 2018
Susan Bewley
Professor of Obstetrics and Women's Health (emeritus)
Mandy Payne, freelance writer, Kent
King's College London
Department of Women and Children's Health KCL, 10th floor St Thomas' Hospital, Westminster Bridge Rd, SE1 7NH