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Consider 1000 women —

I dashed off yesterday’s post in haste. Here is part two.

Please look at this excerpt from the Guardian article of 16th September (I posted a link to it yesterday):

While breast cancer charities welcomed the move, Mia Rosenblatt, head of policy and campaigns at Breast Cancer Campaign, said it was important that women “are presented with the key facts about screening”. But, she added: “However this brings with it the potential that some women will be concerned as a result of this new focus on over diagnosis. This may have an impact on screening attendance.” Screening take-up should now be monitored for any potential fall and all women should attend appointments, she added.

Why? Why, Mia Rosenblatt, should all women attend their appointments for routine breast screening? Should they not think hard first about whether it is worth the risk of overdiagnosis? Or, put another way, should they not think hard about the risk of a lethal cancer being missed if they don’t go for screening?

What’s missing here is readily available support for women to take this difficult decision. However – more good news! – decision aids are being developed. This is what Professor Michael Baum advocated, and Professor Alexandra Barrett from Sydney has been working on for years (see my earlier post, “Anyone Out There”?”). Without much trouble, I have found a document on Google about it. The link to it is given below, and the pretty picture above is taken from it (sorry it is not clearer). The document is said to be for professionals to use with women who are trying to decide whether to take up their screening offer.

But – did I miss something? I wasn’t invited in to use this aid with my GP, or a specially trained nurse. The staff doing the mammogram didn’t go through it with me before they squeezed me into the machine. Is this document – dated 2009 – being used? Or has it been suppressed by pressure groups such as the Breast Cancer Campaign, for reasons that I, for one, can’t fathom?

Let me just reiterate the statistics: over a 10 year period of screening, of the 30 women out of 1000 who get a diagnosis of cancer:

3 will have their lives saved (so screening makes all the difference to them);

5 will die from aggressive cancers anyway, despite having been screened (so screening ultimately makes no difference, though they may start treatment earlier);

22 will get a diagnosis of cancer but will not die (so screening ultimately makes no difference, though they may start treatment earlier). And of these 22, 4 do not actually need the treatment, but are likely to get it anyway. And as to the claim (on that cursed old leaflet, now consigned to the bin, I hope) that this group of women may get away with less radical and extensive treatment because the cancers are caught earlier, let me just remind you that muggins here ended up with a mastectomy. Feels radical to me.

I leave you to figure it out – each of you on your own – until such time as impartial support for decision-making is widely publicised and available to all.

And, Mia Rosenblatt, would such support not be worth campaigning for?

http://www.npc.nhs.uk/therapeutics/other/breast_cancer/resources/pda_breast_cancer.pdf

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