Over the past week, Croakey has been hosting a lively discussion about the merits of breast cancer screening, in the wake of new research highlighting the potential for over-diagnosis and unnecessary treatment. You can read some of the previous pieces here, here and here.
Now Daphne Havercroft, a Founder Member of an advocacy organisation for patients in the UK, called Independent Cancer Patients’ Voice (ICPV), offers her perspective, arguing that women should be given balanced, accurate information, and their personal choices about whether to be screened, or not, should be respected.
She writes:
“ICPV doesn’t have a united view on breast screening. Our members have various views.
But we are united in agreeing that women should have fair and balanced information to make an informed choice about whether or not to be screened. If they choose not to be screened, they should not be made to feel that it is an irresponsible decision, as sometimes seems to be the case.
We welcome the work being done in the UK by Dr Joan Austoker of Oxford University to rewrite the information leaflet sent to women with Breast Screening appointments so that they are told the truth about what is known of the benefits and harms of breast screening. Three of us recently met Dr Austoker and realised what a difficult job she has, because whatever she produces will not please everyone.
It is now well accepted that breast screening will lead to over-treatment for some women. The controversy concerns the statistics about the extent of harms versus benefits.
We hear views from women who have been diagnosed with breast cancer varying from those who are outraged that they may have had unnecessary treatment to those who are convinced their lives were saved by breast screening. The problem is that neither these women nor their doctors can say with absolute certainty whether the treatment was appropriate or whether they were over-treated.
It is unethical for any woman, whether or not she has had breast cancer, to use her views and personal experiences to influence other women as to whether or not to be screened.
That is a decision each woman is entitled to make for herself.
It’s time to move on. ICPV wants to see all women provided with fair and balanced information about breast screening. It must be based on the best available evidence, and be honest about the differing views of experts.
We have a great opportunity to bring a multidisciplinary approach to the future of breast screening by bringing together epidemiologists, breast clinicians, public health experts, researchers, psychologists, cancer patients and women of screening age to understand what we currently know about the biology of breast cancer, what we need to know to better distinguish between disease that will do not harm if left and that which will kill.
Then we must decide on the research priorities that will reduce the incidence of over-treatment, yet not lead to under-treatment. If we make good progress, breast screening information for women will rapidly become out of date and have to be revised every few years as knowledge increases.
Let’s start this work now, for the sake of future generations of women.”
Several commentators are describing the global elevations of breast cancer as an “epidemic.” My empirical evidence does not dispute this description. To mammogram or not to mammogram? Only the woman can decide.
X-rays in the recent past and present have been found to cause cancers – particularly specific type x-rays of the head and neck and to the pelvis of pregnant women which exposes a vulnerable embryo to radiation.
Many health experts claim that the elevation in breast cancer incidence is a result of better detection and the many breast cancer victims I know, have all been devotees of mammogram x-rays at two year intervals. Certainly, the survival rate has improved. So have the profits of relevant industries.
As for me, so far so good and I’ll continue to take my chances. I remain convinced that the fewer x-rays, the better. There’s plenty of scientific literature on the health impacts of low-level radiation i.e. “there is no risk free dose of radiation.”
“Croakey has been hosting a lively discussion about the merits of breast cancer screening, in the wake of new research highlighting the potential for over-diagnosis and unnecessary treatment”!
• I feel as though I know you. You’re caught in the middle between the older generation and the younger generation. You are mother not only to your children, but increasingly to your parents, to younger co-workers, perhaps employees, to older friends and neighbors. But by now, you can handle it. You are accomplished. Your life is organized and running smoothly. You take care of your home, family, job / volunteer work — you get more done and done well in a day than many younger do in a week.
Still, you are looking forward to the day when the demands on you will be fewer, life less fragmented, and you can lavish some time and affection on yourself, and your relationship with your husband and others. You can’t wait to spoil your grandchildren, or to travel, to spend all day in the garden or just read a book. Then you found the lump. Breast cancer. Your first reaction was:
“Well, let’s just get rid of this and get on with life! I can handle this. I’ve handled worse. It’s just a little lump. Cut it out and send me home”. That was Frances Edstrom (Editor in Chief, Winona Post Online) first reaction. “Just cut it out. I thought I could write down the date for surgery on my calendar, maybe have to reschedule a few meetings, cancel a hair appointment, slip this minor disturbance into my busy life. But breast cancer isn’t as simple as that, as just cutting it out. Breast cancer will take all of your skills as an organizer, communicator and researcher. Breast cancer demands you take on new roles”!