Shall we? The vegetable tide is turning. For those of us forcing vegetables into our children in the belief that they are essential to health, the news, from the Journal of the National Cancer Institute: Fruit and Vegetable Intake and Overall Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition reporting a very large study, is that vegetables don’t cut the risk of cancer in the way some analyses had found: Fruit, vegetables, and cancer prevention: a review of the epidemiological evidence
All those UK Department of Health ’5 a day’ campaigns, and attempts to wean us off chocolate bars and onto bananas may have wasted their efforts.
this set of modules is rather good: and Angela Raffle, the public health consultant narrating, has a lovely voice. Quite impressive that it was sponsored by the NHS – if only the same common sense would filter into the actual screening programmes. And here’s another thing of interest to people who are sceptical about screening – a paper co-authored by UK surgeon Mike Baum on the possible hazards of surgery for breast abnormalities. This paper is interesting for a number of reasons. It explores a potential harm that may not have been known, or thought about, when screening programmes were being set up for breast cancer. What makes a good scientist I think has something to do with careful observation, and then challenging oneself and others when the results are unexpected or unexplained.
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.
Is it an unsightly freckle – or a deadly melanoma? To find out, many people now visit private or high-street clinics offering mole checks. Some people say they just want a quick consultation; others seem reluctant to “bother” their doctor. These services have proliferated recently, but how reliable are they?
Dermatology is one of the few medical specialities that still rely, to a great extent, on pattern recognition. Indeed, being able to make a diagnosis from a glance – the role of the consultant during a traditional dermatological assessment – is, I am told, what makes it so satisfying.
Continue reading “Of moles and men”
The last couple of days have spawned a few emails of the political campaigning variety. I understand that evidence-based social policy has the potential to exist – but what I’m really interested in is evidence based health policy.
Being on the receiving end of yet another badly thought out initiative on the basis of policy, not evidence, is dreary never mind bad for patient care. (I have even witnessed a DoH representative accept that her evidence for providing a service showed it expensively didn’t work, only to be told, that it was policy so it was happening regardless.)
So in the red corner, we have Mr Brown saying that if the next election is his, then all cancer patients can have one-to-one nursing at home. This is devoid of reason. Are heart failure patients, bronchitis patients, stroke patients, people with end stage Aids, or renal failure, or dementia somehow less worthy of care?
So last week I had several emails, and then saw several adverts/advertorial, for a device which is being sold in Boots, called ‘Breast Light’. It is almost 90 UK pounds, and it is being given a prominent position in my local store. The website for it claims it is ‘for earlier detection’.
I asked the pharmacist why Boots was selling it. She said it was for patient choice, and it was a useful thing for women to have. I asked her what the evidence was that it worked. She told me to look at the website. Hmm.
I’m amazed by the coverage of the newly-officially-recognised fact that screening can do harm. This article, for example, from this week’s New England Journal of Medicine: Screening Mammography and the “R” Word seems to get all flustered about the potential for women who might benefit from screening mammography ending up not having it, under new age guidelines.
For example: “The most controversial recommendation of the (US Preventative) Task Force is to delay the onset of routine screening mammography from 40 to 50 years of age. Many observers were concerned that this move away from intensive screening might signal a shift away from the war on cancer…But at a deeper level, the recommendations raise concerns about access to potentially lifesaving care. ”
By Rebecca Knight
Have you ever read a newspaper article about cancer risk and felt anxious that something you do – or neglect to do – puts you in danger of developing a terrible disease? Or have you ever watched a television news report about a new cancer drug and felt optimistic – perhaps too optimistic – about a promising breakthrough?
It happens every day, according to an editorial published earlier this month in the Journal of the National Cancer Institute. The editorial, written by the editor and researchers at the Center for Medicine and the Media at the Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire, discusses the exaggerated fears and hopes that often appear in news coverage of cancer research. Promoting Healthy Skepticism in the News: Helping Journalists Get It Right
In September this year, a young woman fell ill and died, hours after she was injected with Cervarix, the vaccine intended to prevent cervical cancer.
Several media reports questioned the safety of the vaccine and called for the schools vaccination programme to be scrapped. The batch of vaccine was quarantined until investigations could be completed, but after a postmortem concluded that the schoolgirl had died of a previously unknown tumour, the vaccination programme continued.
I am no great fan of Cervarix, but not for safety reasons. Rather, I am not convinced that doubts about its performance have been adequately addressed by research. The management of this unexpected fatality, however, was faultless. The possible link to the vaccine was instantly spotted and properly reacted to. Deaths in young schoolgirls are uncommon, so the potential danger was easier to identify, and in this case it was relatively easy to rule out.
The remainder of this article can be read here. Please post comments below.
News from the US, I can scarcely believe it: The New York Times reports that the American Cancer Society now accepts that screening for breast and prostate cancer is not only inefficient, but frequently inaccurate and alarmist. It has realised that such programmes – designed to detect cancer early – can do damage too, because they often detect cancers or pseudocancers that were never going to maim or kill.
That is the bit I can believe. After all, these are evidence-based observations, and none is particularly new. A recent paper in the Journal of the American Medical Association (Jama) also highlighted the weaknesses of screening. What I have difficulty with is that paper’s conclusion: “To reduce morbidity and mortality from prostate cancer and breast cancer, new approaches for screening, early detection, and prevention for both diseases should be considered.” The problem with screening and even early detection is that because these two elements sound useful, we have great difficulty in believing it when the evidence tells us they are not.
The Jama paper states that, after 25 years of screening, “conclusions are troubling: Overall cancer rates are higher, many more patients are being treated, and the absolute incidence of aggressive or later-stage disease has not been significantly decreased”. The authors also say that screening comes at significant cost, including overdiagnosis and overtreatment. The complications of therapy are likely to get worse as the population ages. Not only that, but treatments for relatively indolent disease may in themselves do harm.
The remainder of this article can be read here. Please post comments below.