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Breast cancer: study claiming that screening women in their 40s saves lives “found the opposite,” say critics

BMJ 2020; 370 doi: (Published 13 August 2020) Cite this as: BMJ 2020;370:m3191

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Re: Breast cancer: study claiming that screening women in their 40s saves lives “found the opposite,” say critics

Dear Editor,

Recruitment of the 160,921 women in this study took place from 1990 to 1997. We learn that `women in the intervention group were unaware of the study`. [1] In other words, they were denied their right to consider whether they wished to participate in the study. Screening by mammography is not without potential for harm: properly informed consent should have been sought from these asymptomatic citizens. [2] The fundamental principle of the Declaration of Helsinki, of respect for the individual and the right to make informed decisions, was ignored.

In July 1995, the House of Commons Health Committee published their Minutes of Evidence and Appendices in their Third Report, on Breast Cancer Services. [3] In the hearing on 30th March 1995, as a witness, I was asked by Alice Mahon, MP, “Mrs. Thornton, why do you think that the NHS Breast Screening Programme is, in your words “a costly trawl of an asymptomatic public group…creating huge costly psychological and physical morbidity”? Part of my answer was that it was because it “focuses on the women who benefit, in other words, the one life that is saved, and it overlooks the hundreds of women that go through the process and in some cases suffer psychological harm for that one. It is unbalanced and disproportionate and should be reviewed, in my opinion, at the moment.” Alice Mahon`s final question to me was “So you want a review then?” to which I replied “I do want a review.” I was not alone in wanting that!

After much clamour and controversy, an Independent Review took place in 2012. Much had happened in the years before its report was published in 2013, [4] and has thereafter. Treatments had improved enormously; women were presenting at an earlier stage in the disease; more evidence and information had become available and accessible to citizens. The magnitude of the harms inflicted on these unsuspecting and unaware women had also been quantified. [5] But reviews and sound evidence about harms and overdiagnosis have had little impact on all those who still talk in terms of `saving lives`, who disregard the collateral damage of the numerous harms suffered by hitherto asymptomatic citizens recruited to a study, some without their consent. They seem unable to see the wasteful disproportionateness of their stance at a time when currently, in the UK, for example, 1.85 million people are waiting for treatments put on hold in this time of pandemic. Only Covid-19 seems to have had the power to put a stop to breast screening when evidence, reason and clamours for distributive justice have not.

Meanwhile, the sick and ill suffer and wait, while statistics are presented that demonstrate the failure of devotees to get a grasp of the folly and injustice of attempting to increase the numbers of citizens who will be indisputably be harmed by widening the age range, with minimal or no benefit.

[1] Duffy S, Vulkan D, Cuckle H, et al. Effect of mammographic screening from age 40 years on breast cancer mortality (UK Age trial): final results of a randomised, controlled trial. Lancet Oncol2020. doi:10.1016/S1470-2045(20)30398-3.

[2] Declaration of Helsinki

[3] Health Committee Third Report Breast Cancer Services Volume II Minutes of Evidence and Appendices. London HMSO 6th July 1995.
Hazel Thornton. Written evidence, pages 106-114: Page 111: Progress of NHS Breast Screening Programme.
Hazel Thornton. Oral evidence. Pages 123-124.

[4] Marmot G, Altman DG, Cameron DA, Dewar JA, Thompson SG, Wilcox M The Independent UK Panel on Breast Cancer Screening (2013) The benefits and harms of breast cancer screening: an independent review. Br J Cancer 108 (11): 2205–2240.

[5] Cochrane Review: Gøtzsche PC, Jørgensen K Screening for Breast cancer with mammography. June 2013

Competing interests: No competing interests

13 August 2020
Hazel Thornton
Honorary Visiting Fellow, Department of Health Sciences
University of Leicester
"Saionara", 31 Regent Street, Rowhedge, Colchester, CO5 7EA