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Head of Policy at Breakthrough Breast Cancer, Dr Sarah Rawlings, appeared on BBC One's The One Show to take part in a discussion about the National Breast Screening Programme and its review. CAN (Campaign Advisory Network) member Marilyn Morris was also interviewed about her experience of having her breast cancer picked up through breast screening.
Breakthrough Breast Cancer has put together the following information for anyone who may have concerns or queries about screening.
Routine breast screening
The aim of breast screening is to detect cancer at a very early stage, before other signs and symptoms are apparent. The sooner cancer is detected the better, as treatment is more likely to be successful and options less aggressive. The NHS Breast Screening Programme (NHSBSP) estimates it saves around 1,400 lives in England every year thanks to the early detection of breast cancer.
Criticism of routine screening
However, screening is not perfect. Screening is associated with something called over-diagnosis. This is when a cancer is detected which may be so slow growing that it will not cause harm to that woman or result in symptoms. However, it is not possible to know which cancers will grow and become harmful and which won’t, so all women diagnosed with cancer are offered treatment.
Critics therefore argue that by attending screening a woman may be diagnosed with cancer that, had she not attended, she’d have never known about (since the tumour may not have resulted in symptoms in her life time). There is a large amount of debate on what the rate of over-diagnosis actually is and different scientists have come up with very different estimates.
The review of the NHS Breast Screening Programme
There is a large amount of debate on the risks and benefits associated with routine breast screening. This relates both to the number of breast cancer deaths it may prevent and to the rate of over-diagnosis. In order to address this debate and answer some of the criticism of the NHSBSP the National Cancer Director has commissioned a review of breast screening.
The review will be undertaken by an independent panel who will study all the latest evidence on breast screening. Their aim is to provide an up-to-date estimate of the likely benefits and harms associated with routine screening, allowing them to decide if the current screening programme in England needs to be changed.
Depending on the outcome, the breast screening programmes in the other home nations may also decide to alter their services.
The review will also look at the information that is provided to woman when they are invited to go to a screening appointment and will investigate the best ways to present the facts and figures relating to the NHSBSP.
Breakthrough's view on breast screening
Despite the criticism of the NHSBSP, Breakthrough believes screening plays an important role in preventing deaths due to breast cancer and the best available scientific evidence supports this. We believe the benefits of screening outweigh the risks and screening saves lives since it is currently the best method of detecting cancer at an early stage when treatment is more likely to be successful.
However, we recognise screening is not without weaknesses and issues such as over-diagnosis are a concern.
Because of the possible risks and downsides associated with screening, Breakthrough recognises that the choice to attend screening can only be made by the individual. We therefore believe it is important that women have access to clear, honest, accurate and balanced information outlining the benefits and limitations of breast screening to allow them to make an informed choice as to whether or not to attend their breast screening appointment.
We welcome the review of the NHSBSP as we hope it will not only provide clarity on how effective the programme is but also ensure the information that women receive is of the highest quality, allowing them to make an informed choice about whether they should attend.
In the meantime if women have concerns we advise they discuss these with their doctor.
For more information, please email supportercare@breakthrough.org.uk.