CHSS Senior Clinical Research Fellow Dr Lindsay Forbes says failures like the one that led to 450,000 women missing breast cancer mammograms are rare but that anyone with breast symptoms should visit their GP promptly for investigation and not rely on screening.
With anxious women inundating a breast cancer screening helpline, Lindsay says screening can save lives but that it can also cause harm because of overdiagnosis. ‘It may seem astonishing that this problem was not picked up before now. Jeremy Hunt acknowledged that oversight of the NHS Breast Screening Programme may have been inadequate. The Breast Screening Quality Assurance Service has experienced a cut in funding, and the Health and Social Care Act 2012 fragmented the public health workforce and its capacity for monitoring local screening performance. What is even more astonishing, however, is that this kind of error is rare, thankfully. NHS IT systems are vast and complicated and, generally speaking, operate strikingly well.
‘The Inquiry will examine the clinical impact of the error, in particular, the critical issue of whether any women have died prematurely as a result of not being invited for screening. An Independent UK Panel in 2012 estimated that breast screening reduces the risk of breast cancer death by between 11 per cent and 27 per cent, but this is considered by some to be an overestimate. Breast screening can also cause harm: for every woman whose life is saved by breast screening, it is thought that three are overdiagnosed – that is, are treated for a breast cancer that would not have caused them any clinical problems.
‘Therefore, some of the women not invited for screening as a result of the error will have benefited from it, in that they will not have received a diagnosis and treatment for a cancer that would never have come to light and certainly would not have killed them.
‘What is vital is that women with breast symptoms go to their GP promptly for investigation – not screening – as soon as possible. Women with cancers diagnosed at an early symptomatic stage have a high survival rate. We need to see whether women who should have been invited for screening between the ages of 68 and 71 and were subsequently diagnosed with breast cancer had delayed going to see their GP – perhaps falsely reassured by previous normal screens.’
Lindsay is a Senior Clinical Research Fellow with CHSS. For more information view her staff profile
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