Intended for healthcare professionals

Rapid response to:

Re: Mammography wars

BMJ 2011; doi: (Published 27 November 2011) Cite this as: BMJ 2011;:

Rapid Response:

Re: Mammography wars

So it is not appropriate for NICE to review breast screening policy because they only give clinical guidance. The appropriate body to review evidence for screening is the NHS Cancer Screening Programmes in England headed by Julietta Patnick and Mike Richards, and "if there is reason to significantly alter the policy position" they would refer it to the UKNSC whose remit is making policy recommendations.

So the people to examine the evidence are the ones who have already made up their minds about it, have a personal interest in the programme, and have demonstrated a disinclination to address evidence that might suggest need for reform.

The NSC make policy recommendations but don't actually examine evidence or make decisions, since the CSP has to judge that there is need to change policy before they even mention it to the NSC. But the CSP ignore evidence and think everything is hunky-dory apart from the fact that as far as they're concerned not enough people attend, so they won't be mentioning anything to the NSC. What, apart from twiddling their thumbs, does the NSC actually do?

This confirms what I have suspected from the stonewall response to those who raise serious concerns with the CSP and NSC: the CSP are a law unto themselves, answerable to nobody. They do whatever they like, which has little to do with the wellbeing of British women, and abuse what is in practice unrestricted licence. What has Mike Richards been doing for 12 years except asking the advisory committee how they're getting on, being told, "Famously" and saying "Goodoh"?

The NSC’s remit is to advise Ministers on “the case for continuing, modifying or withdrawing existing population screening programmes. In particular, programmes inadequately evaluated or of doubtful effectiveness, quality, or value” and to do this “The UKNSC regularly reviews policy on screening … in the light of new research evidence becoming available.” So do they or do they not look at evidence; do they or do they not review policy? Can they or can they not grasp the evidence, including the evidence that those they rely on to notify them of need for change flagrantly disregard evidence for flagrantly unprofessional reasons? Have they no initiative? Can they or can they not talk to the CSP and ask them to account for their behaviour, for the evidence, and for the programme?

Ms Mackie mentions an internationally agreed set of programme appraisal criteria to assess screening programmes. The breast screening programme fails on points 2, 10, 13, 14, 15, 20 and 21 at least. But the CSP does not consider a plethora of serious research good reason to notify the NSC that there may be cause to alter policy, the NSC, who should review policy on screening in light of research dozes, awaking from their slumbers to announce they don’t want NICE to do it either.

Meanwhile, the National Health Service Breast Screening Pogrom continues.

Competing interests: Diagnosed following screening

27 November 2011
Miriam Pryke
PhD student
King's College London
Strand, London, WC2R 2LS