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How could a radio broadcast on self-examination have avoided creating misperceptions?

BMJ 2024; 385 doi: https://doi.org/10.1136/bmj.q1100 (Published 16 May 2024) Cite this as: BMJ 2024;385:q1100

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Re: How could a radio broadcast on self-examination have avoided creating misperceptions?

Dear Editor,

It is often quoted that “Where ignorance is bliss `tis folly to be wise” [1] The history of DCIS is a perfect example!

In his Opinion piece, [2] Richard Smith references his blog about DCIS written in 2011. [3] Two sentences in that blog especially repay careful thought. First: `I think that not sharing uncertainty is in some senses “lying” and a kind of abuse, particularly if the information leads a woman to opt for a treatment that she would not have chosen if fully informed.` And the second: `I found myself wondering whether we would be better or worse off if we had never invented mammography and hadn’t opened the Pandora’s box of DCIS.` I agree.

Even after all these years, millions of words and reams of data later, there is still uncertainty about the nature of DCIS, and no consensus about how to label it or how best to deal with it. It would indeed have been better if `we had never invented mammography`. But, `fully informed consent` is (still) an impossibility – as I surmised myself back in 1992! [4]

The concept of `health` and its definition have also been widely discussed. It is generally agreed that it is more than just a disease-free body. What is certain is that citizens are being made increasingly anxious by the zealous pursuit of an unattainable goal, with too much energy focussed on what might happen to the body, rather than living positively and hopefully, `warts and all`.

In his concluding paragraph [2] Richard Smith wonders how the broadcast could have avoided promoting these misperceptions about DCIS. His first suggestion, which he thought was probably the best, is the one that I would heartily endorse, i.e. not to have had the broadcast at all.

Another pertinent quote from [1]:
`Alas, regardless of their doom,
The little victims play!
No sense have they of ills to come,
Nor care beyond to-day:
Yet see how all around 'em wait
The ministers of human fate,
And black Misfortune's baleful train!`

Refs:

[1] Thomas Gray, (1716-17710. Ode on a distant prospect of Eton College.

[2] Richard Smith. How could a radio broadcast on self-examination have avoided creating misperceptions? BMJ 2024;385:q1100

[3] https://blogs.bmj.com/bmj/2011/09/07/richard-smith-communicating-with-pa...

[4] Thornton, H.M. Breast cancer trials: a patient`s viewpoint. The Lancet. Vol.339.Jan 4, 1992

Competing interests: No competing interests

16 May 2024
Hazel Thornton
Independent Citizen Advocate for Quality in Research and Healthcare
University of Leicester (Hon. DSc. (Leicester))
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