Friday, October 20, 2006

Yesterday's Papers, Yesterday's Girls

SCREENING FOR BREAST CANCER 'MAY HARM WOMEN' screams the front page of the Daily Telegraph:

Breast cancer screening may be doing more harm than good, a new report says yoday.
The research found that for every 2,000 women invited to have mammograms, one would have their life prolonged but 10 would endure potentially devastating and unnecessary treatment.
It suggested that most women having surgery, including mastectomies, radiotherapy and chemotherapy, following screening do so even though abnormalities identified in their cells would not have become a problem during their lifetime.
The research, a major review of studies covering half a million women, is published by the internationally-respected Cochrane Library.
Prof Michael Baum, a pioneer of England's £75 million-a-year screening programme, called for the National Institute for Health and Clinical Excellence to investigate whether it should continue.
Let me first acknowledge that we have a little bit of involvement here as we coded the current versions of the PERFORMS and REPORTER systems that radiologists in the UK use to get feedback on their breast screening skills and diagnostic performance, but I think that this is a deeply irresponsible headline. Read it again: SCREENING FOR BREAST CANCER 'MAY HARM WOMEN'.

Balancing the potential harm of false positive diagnoses against potential death sentence of false negatives is a serious business, but no scan means no diagnosis and for lives to be saved breast screening must detect cancers in the early stages.

Over diagnosis may have been a problem in the past, and for all I know - God knows I'm no expert - may even be a problem now, but I do know this; the combination of a growing library of scans for which the ultimate pathology is known, research and improvements in technology, plus the developing experience and skills of radiologists is bound to make diagnosis better.

Loose talk about closing the screening system down does a profound disservice to the future.

It is a bit like proposing that we stop weighing ourselves because the much touted Body Mass Index is such an imperfect indicator of present and future health.

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