October 26, 2011
Independent Review Of NHS Breast Screening Underway, Reveals Top Cancer Doctor
Letter: The NHS breast screening program needs independent review
An independent review of the NHS breast cancer screening programme is under way, Professor Sir Mike Richards, National Cancer Director, told the BMJ today.
His announcement follows an open letter from Professor Susan Bewley, Consultant Obstetrician at King's College London, urging Professor Richards to initiate a review of the evidence in light of growing uncertainty over the benefits and harms of breast screening.
Evidence from the Nordic Cochrane Centre suggests that the harms of breast screening may outweigh the benefits and that screening information should be more balanced.
Professor Bewley agrees, saying she found the NHS leaflets "exaggerated benefits and did not spell out the risks." She adds: "The oft repeated statement that "1400 lives a year are saved" has not been subjected to proper scrutiny."
When she expressed her misgivings to Professor Richards, he replied "that the large majority of experts in this country disagrees with the methodology used in the Cochrane Centre reviews of breast screening." But Professor Bewley says this argument "is inadequate and unpersuasive."
She writes: "In the past few years, British women have not been told about the genuine doubts," and warns that the new leaflet "is still not good enough."
"I am not convinced that you have challenged your experts competently and mercilessly, rather than hidden behind them. Thus I support the calls for an independent review of the evidence - a review that will not be kicked into the long grass, whose findings will be widely and properly disseminated, and that will adjust screening policy appropriately and will lead to proper pursuit of the research implications."
In his reply, Professor Richards says that he believes "screening programmes should be based on the best available evidence," and based on current advice, including that of the World Health Organisation, breast screening saves lives and the benefits considerably outweigh the harms. However "the ongoing controversy should, if at all possible, be resolved."
As such, he has initiated an independent review of the research evidence which, once concluded, will be presented to experts from both sides of the argument. A new process for developing written information for the public about each screening programme is also being established, he says, and the breast screening leaflet will be one of the first products to be revised through this new process.
"I hope this reassures you that I take the current controversy very seriously," he writes.
"Should the independent review conclude that the balance of harms outweighs the benefits of breast screening, I will have no hesitation in referring the findings to the National Screening Committee and then ministers. You also have my assurance that I am fully committed to the public being given information in a format that they find acceptable and understandable and that enables them to make truly informed choices."
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