Monday, November 05, 2012

Reducing harm

Sunday’s Feedback on Radio 4 carried protests over the fact that the Radio 4 Today programme item about breast cancer screening had featured 2 male experts & a male interviewer. This is part of a long-running guerrilla campaign against male bias in the programme, & claims that strenuous efforts had been made to find eminent women qualified to take part were treated with scorn.

Surprisingly, perhaps, the independent inquiry team which looked at risks & harms of the national breast cancer screening programme itself consisted of 5 male professors (2 cancer specialists with three statisticians/epidemiologists) plus one female independent patients advocate.

Perhaps all those of a female persuasion who are considered eminent enough for the Today programme are working on the Million Women Survey, which is linked to the national breast screening programme, & so would disqualify them as biased rather than independent. Or perhaps they were simply unable to make themselves available for interview at 0709 on a Tuesday morning.

The Today programme pointed out that they did interview two women about their own experience of screening.

On balance, taking all the evidence into account, Cancer Research UK continues to recommend that all women go for breast screening when invited. I should really like to hear a debate between women as to whether, on balance, they think it a price worth paying, that for every woman whose life is saved, three receive treatment which is, strictly speaking, unnecessary. Even though – or especially as – we can never know which was which.

And especially bearing in mind one ‘harm’ which is not, I think, addressed by this report. On current practice, any close female relative of a woman who does receive a diagnosis of breast cancer will automatically move in to a higher risk category herself. Presumably in some cases her risk will be only of getting the same kind of ‘non-threatening’ cancer.

Falling limits of detection always cause dilemmas about what to do about potential harms which were previously only known to exist at levels which made the damage all too obvious. It is only within my lifetime that we have bee offered the chance to spot a cancer long before it makes its presence only too evident, & we may all have to learn to cope with the novel idea of a cancer which will not cause your life to end.

On a more optimistic note, there is some interesting stuff from Cancer Research about the possibility of greatly reducing future numbers of women invited to undergo a mammogram by identifying those at greater than average risk of breast cancer; which, fingers crossed, should go a long way to mitigating the harms of the programme.

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