A letter to The Times signed by 15 HealthWatch experts and supporters sparked a deluge of media coverage when it urged women offered catch-up after missed breast screening invitations to “look this gift horse in the mouth”.
HealthWatch chair, Susan Bewley, professor of women’s health at King’s College London, penned the letter on learning the news that an estimated 450,000 women aged 68-70 had not been invited to routine NHS mammography screenings because of an IT failure dating back to 2009. Jeremy Hunt, the health secretary, had claimed that between 135 and 270 women might have had their lives shortened as a result.
These figures, based on statistical modelling, were disputed by many in the medical and statistical community, and Bewley’s letter quickly gathered signatories from among HealthWatch supporters including Michael Baum, who as professor emeritus of surgery at University College London was an architect of the original breast screening programme in the 1980s.
"Breast cancer screening mostly causes more unintended harm than good"
The letter, headed “Screening ‘flaw’”, appeared on Saturday 5th May and was accompanied by a page 9 article by Chris Smyth, The Times’ Health Editor, titled “Women are urged to avoid catch-up breast screening”. It quoted from Bewley’s letter, “The breast screening programme mostly causes more unintended harm than good, which is slowly being recognised internationally. Many women and doctors now avoid breast screening because it has no impact on all-cause death”.
Here is a list of just some of the media coverage that resulted:
- BBC News (5th May): “Breast cancer screening programme 'does more harm than good'” quoted from the letter, saying “The claims of lives saved because of breast screening are counteracted by deaths resulting from interventions, the medics said. And the most dangerous and advanced cancers are not prevented by screening programmes”.
- BBC Radio 4 News programme (5th May, 6:00am, 6:25mins in, and again at 13:00) reported the Times letter and the disadvantages of breast screening.
- Dr Margaret McCartney, HealthWatch patron and our 2008 HealthWatch Award winner, joined Susan Bewley and broadcaster Nick Ross, HealthWatch’s president, in a further letter published in the Guardian, 7th May: “Impact of mass breast cancer screening has been overrated” which called on Public Health England to “publish its modelled estimates so scientists and statisticians can check them. In the absence of good evidence it was disgraceful to suggest women died needlessly.”
- Margaret McCartney wrote in the BMJ on 14th May (BMJ 2018;361:k2055) “Can we now talk openly about the risks of screening?” criticising the government’s plan to extend the screening age range in a massive clinical trial without participants’ consent.
Other publications home and abroad took apart the Department of Health’s wobbly maths.
- Tim Harford, our 2012 HealthWatch award winner, covered the issue in his BBC Radio programme “More or Less” (4th May), interviewing Karsten Jorgensen about screening research that shows doubtful benefits, and later wrote in the Financial Times (11th May): “Breast cancer scare recalls the value of collecting evidence” of the “widespread indifference of a howling media to the evidence that such screening is of doubtful benefit anyway”.
- David Spiegelhalter, statistician of the Winton Centre in Cambridge, wrote (2nd May): “Have ‘up to 270 women died’ by missing a breast screening appointment letter?” concluding, that 800 may have avoided harm by not being screened.
- The Guardian (4th May): “Breast cancer screening scandal must prompt review of mammograms” by GP Kailash Chand.
- Nigel Hawkes in the BMJ, 8th May (2018;361:k2036): Breast cancer screening error: fatal mistake or lucky escape?
- Lown Institute: “Slow progress in reducing breast cancer overscreening”
- HealthNewsReview.org (7th May): “Despite screaming headlines, England’s breast cancer screening computer glitch didn’t kill anyone”
- And the ability of the NHS to cope with the demand for catch-up screening was called into question when the Society of Radiographers announced on 14th May “Breast screening workforce will not be able to cope with backlog following crisis, unless urgenly reinforced”.
- And finally … Private Eye, in its “Medicine Balls” column this week, noted that while medical negligence lawyers are licking their lips, it will be nearly impossible for anyone to prove a life had been shortened. On the contrary, “By opting out of screening, a women will lower her risk of being labelled and treated for early breast cancer with no benefit to her quality of life or life expectancy.”
HealthWatch has been raising concerns about breast cancer screening and its shaky evidence base since 2001, and continues to work to raise awareness of the risks and promote correct information to doctors and the public to enable informed choice.