29 October 2014
Media contact: Media
HealthWatch commentator: Susan Bewley, Honorary Professor of Complex Obstetrics, Kings College London
HealthWatch welcomes the publication of this report and congratulates the members of the committee for their efforts and patience in the process of hearing evidence, and for publishing a full and considered report.
In particular we would like to comment on the following recommendations, many of which reflect calls that HealthWatch has been making for some time now:
We agree that there should be clarification regarding the Government’s position regarding the extension of the breast screening programme, and the evidential basis for the Government’s position on this programme to be detailed.
There is no evidence to support extension of the programme. The age extension trial protocol is flawed and women are expected to give ‘implied’ consent based on false information. The NHS Breast Screening Programme has repeatedly been unwilling to engage in discussion of the shortcomings. Further, while we praise the work of Ann Mackie and the National Screening Committee, it is high time the trial management was called into question: the chief investigator is not medically or scientifically qualified, runs the national screening programme and also chairs the trial steering committee, and by obfuscation has perpetuated a dangerous lack of transparency in this trial. 1-5
We welcome the proposal that the Office for National Statistics review and validate the statistics presented in NHS information materials on breast screening to ensure that the uncertainties in estimates of benefits and harms are expressed in a clear, accessible way.
The published evidence shows that regular mammograms of healthy women have no impact on risk of all-cause death, though they increase the risk of mastectomy and cause much overdiagnosis and overtreatment. We would welcome clear, simple standards for information, such as the ‘Fact Boxes’ from the Harding Centre for Risk Literacy. 6,7
We agree that the NHS Health Check programme, which was introduced without an evidence base, be scrutinised by the UK National Screening Committee, retrospectively, to address concerns that it could be wasting resources.
We welcome a proper review of the evidence. It is intolerable that senior people at the Department of Health (and now Public Health England), who were well qualified to know better, both denied that the Health Check Programme was screening and then set upon a course that wastes billions of taxpayer’s money when they knew the economic analysis was flawed and that it doesn’t save lives.
We support the proposal that the lack of clarity between the UK National Screening Committee and Public Health England is promptly addressed by drawing up a memorandum of understanding to be placed in the public domain no later than December 2014.
We are delighted that the committee recognised the need to protect scientific integrity and independence from the risk of political interference. All screening brings harms, and some screening brings benefits. Popular appeal does not make unconstrained screening programmes safe. 8,9
We wholeheartedly support a move for any systematic, population-based intervention that “looks like” a screening programme, be subject to evidence review by the UK National Screening Committee (UK NSC).
While we agree with the proposal that front-line health care professionals delivering screening programmes receive regular training to refresh their communication skills, this should be in the context of screening tests for which there is evidence of benefit. In the case of PSA screening for prostate cancer, for example, it is too early to say definitively whether PSA screening provides anything other than marginal benefit.
We would question the proposal that the UK National Screening Committee, in its response to this report, should “proactively engage with a broader range of stakeholders”. The UKNSC already consults widely. Giving fringe groups more influence might result in pressure to put in poor screening tests which cause more harm than good.
- ENDS -
- Bewley S. Legal scrutiny of the age extension breast screening trial is required. Medico-Legal Journal 2014;82(4): (in press)
- Bewley S, Rose L, Gøtzsche P. Time to halt an out of control trial with ineffective oversight. BMJ 2014;349:g5601
- Age Extension trial invitation letter and leaflet.
- HealthWatch concerns over age extension trial of breast screening.
- The protocol of the age extension trial of breast screening.
- Gigerenzer G. Quoted in Kremer W. Do doctors understand test results? 7 July 2014 http://www.bbc.co.uk/news/magazine-28166019
- Harding Centre for Risk Literacy https://www.harding-center.mpg.de/en/health-information/facts-boxes/mammography
- Biller-Andorno N, Jüni P. Abolishing Mammography Screening Programs? A View from the Swiss Medical Board NEJM 2014;370:1965-67
- de Glas NA et al. Effect of implementation of the mass breast cancer screening programme in older women in the Netherlands: population based study. BMJ 2014;349:g5410
HealthWatch is a UK charity established in 1991 to promote evidence in healthcare and quality information for the public. It has no connection whatsoever with the government “Healthwatch England” initiative.