A collection of papers published today in the Journal of Medical Screening affirm that breast screening is a good thing. The first, from the Wolfson Institute of Preventive Medicine, takes two sets of data – one from a randomised trial in Sweden, and the other from England’s Breast Screening Programme (and not, therefore, a randomised controlled trial.) The paper concludes that “between 2 and 2.5 lives are saved for every over-diagnosed case.”
The second paper is regarding the ‘Age’ trial. The women were randomised to either screening from age 40/41 or age 48. They concluded that uptake was “comparable with that in the UK screening programme”. The conclusion I expect to be put out in a small media gale is that breast screening is good, desirable, and that woman want to have it.
I fear that this will not take us to the real argument about breast screening which we do need to have. Given what we know about breast screening (and we could pick holes in this trial, not just about the fact that breast cancer deaths are declining independent of screening) – which is best seen in Cochrane reviews (when all the evidence, not just the bits that fit your argument, are assessed) about breast screening. We know that overdiagnosis, with all the attendant surgery, chemo or radiotherapy, exists. But most women attending for breast screening do not. The real debate needs to be with each woman as she is given properly informed consent so that she can choose to have, or not to have, screening. An independent review of the cost effectiveness of breast screening is sorely needed.