Study suggests mammograms may cause more harm than good

An independent review of breast screening in the UK is under way after researchers suggested the harms may outweigh the benefits.

Professor Sir Mike Richards, national cancer director at the Department of Health, has initiated an independent review of research evidence after an argument arose among academics over the worth of mammograms.

Last month, researchers from the Nordic Cochrane Centre in Denmark claimed women undergoing NHS breast cancer screening are being “misinformed” and are not told about the harms of over-diagnosis.

They said the harms of breast screening may outweigh the benefits and that screening information should be more balanced.

In an open letter to Sir Mike, published in the British Medical Journal, Professor Susan Bewley, consultant obstetrician at King’s College, London, agreed.

She writes that she found the NHS leaflets “exaggerated benefits and did not spell out the risks”, adding: “The oft-repeated statement that ’1,400 lives a year are saved’ has not been subjected to proper scrutiny. Even cancer charities use lower estimates.”

She wrote to Sir Mike: “I am not convinced that you have challenged your experts competently and mercilessly, rather than hidden behind them.

“Thus I support the calls for an independent review of the evidence – a review that will not be kicked into the long grass, whose findings will be widely and properly disseminated, and that will adjust screening policy appropriately and will lead to proper pursuit of the research implications.”

In a letter of response, also published in the journal, Sir Mike revealed the initiative which he instigated “some weeks ago”.

Sir Mike said that “screening programmes should be based on the best available evidence”. Based on current advice, breast screening saves lives and the benefits considerably outweigh the harms.

But he said he believes that the controversy should be resolved, so he launched the review. Once concluded, it will be presented to experts from both sides of the argument.

“I hope this reassures you that I take the current controversy very seriously,” he wrote.

“I will do my best to achieve consensus on the evidence, though I realise this may not ultimately be possible.

“Should the independent review conclude that the balance of harms outweighs the benefits of breast screening, I will have no hesitation in referring the findings to the UK National Screening Committee and then ministers.

“You also have my assurance that I am fully committed to the public being given information in a format that they find acceptable and understandable and that enables them to make truly informed choices.”

Sara Hiom, director of health information at Cancer Research UK, said the review was “needed”.

She said: “Independent experts will be leading the review and we will then host a workshop to discuss the findings, inviting representatives from both sides of the argument.

“We mustn’t lose sight of the fact that the fundamental principle underpinning screening – that earlier diagnosis helps improve outcomes – is right and that screening does help save lives.

“This is not a review of all screening programmes – the evidence for bowel and cervical screening is unequivocal, they will save thousands of lives every year.

“It is important that this debate about breast screening is dealt with objectively, transparently and as swiftly as possible.

“Women need more accurate, evidence-based and clear information to be able to make an informed choice about breast screening. The decision whether to be screened is a personal one, but that decision should be made with all of the potential harms and benefits fully explained.”

Dr Emma Pennery, clinical director at Breast Cancer Care, said: “We want all women to have access to clear information about both the benefits and limitations of screening to help them make an informed choice about whether to attend.

“We know from calls to our helpline that conflicting opinions about screening can be confusing for people and adds to their anxiety, so we welcome an independent review which aims to find consensus.”

The NHS Breast Screening Programme in England is gradually being extended to women aged 47 to 73. Screening is routinely offered every three years to women aged 50 to 70.

Women over this age can request screening.

A Department of Health spokesman said: “Our advice has not changed – we urge all women to go for breast screening when invited.

“The best available evidence shows that screening saves lives by detecting cancers earlier than they would otherwise have been.

“Our screening programme has always been regularly scrutinised and evaluated.

“We know that some scientists differ in their views towards screening, so in order to find consensus we have asked the national cancer director, Professor Sir Mike Richards, to review the evidence in partnership with Harpal Kumar, chief executive of Cancer Research UK.

“We will look at the findings of the review.”