Tag Archives: preventative medicine

Breast Screening – The Truth…

I am against over-medicalisation in all its forms. So, apart from being very skeptical about preventative medicine in the area of heart disease, I also worry about other forms of preventative medicine. Breast cancer screening is one area where the balance between benefit and harm may well slip towards harm. Yet, it is presented as an absolute good.

One man who is very critical of breast cancer screening  is Professor Peter Gotzsche, who is the clinical director fo the Nordic Cochrane Collaboration Centre, and has written a book called ‘Mammography Screening. Truth, lies and controversy.’ He outlines exactly what has been going on in this are, and makes it very clear that there are significant problems. Primarily with overdiagnosis (there are other problems, but no time for everything in one blog).

Overdiagnosis means finding ‘lumps’ of other suspcious things on mammography ‘lumps’ that would never have caused any problem.  How big is this problem. Well,  detailed pathological studies done in Australia found that in women who had died of other thngs (not breast cancer) had the following pathologies, any of which could lead to a ‘diagnosis’ of breast cancer if found on a biopsy :

Hyperplasia 12.6%
Carcinoma in situe 13%
Focal secretory changes 24.1%
Perilobular hemangioma 11.2%
Radial scars
(precursor of infiltrating ductal cancer)


In other words, a very high percentage of women have ‘cancerous’ lesions in their breasts. Yet, around 4% of women die of breast cancer.  In the words of the authors of this study…

‘….in any case, the high frequency of ductal hyperplasia and CIS (carcinoma in situ) 25.6% suggests that only a small proportion of these must ever progress to invasive carcinoma.’

If only a small proportion of ‘cancerous’ lesion actually progress to invasive carcinoma, then the majority of those found would never cause any harm to the woman. Thus overdiagnosis must be a very major problem indeed. Ironically, the more detailed an accurate screening beomces, the more overdiagnosis will occur.

Anyway, I was unsurprised to see the recent headline:

‘Breast cancer screening does ‘more good than harm’ http://www.bbc.co.uk/news/health-19571173

‘Breast cancer screening saves the lives of two women for every one patient who receives unnecessary treatment, according to a major European review. There has been a fierce debate about the use of screening, and policy is being reviewed in England.

The latest study, published in the Journal of Medical Screening, said at least seven lives were saved for every 1,000 women screened. Health charities say the findings will provide further clarity for women. Tens of thousands of women die from breast cancer across Europe each year. The effectiveness of screening programmes across the continent was evaluated in a series of studies.

It concluded that for every 1,000 women screened, between seven and nine lives were saved and four cases were over-diagnosed.. Mammograms spot dangerous tumours, increasing the chances of survival, but also detect lumps that are essentially harmless, exposing some women to undue anxiety and surgery.

Screening doesn’t just save lives today or tomorrow, it saves lives 10-20 years down the line” Prof Stephen Duffy Queen Mary, University of London.’

I know that there is no possible way that anyone can know that for every seven and nine lives ‘saved’ four cases were overdiagnosed. This is scientific nonsense. The reality is that more cases must have been overdiagnosed than future invasive cancers diagnosed.

I have asked someone to forward me the full studies on which this BBC story was based.  I have only one part of it so far, and it is a part that worries me greatly, for it makes the following statement.

‘What these papers tell us is that the time has come to move away from relying solely on the older randomized trials of mammographic screening for the evidence-base, and to use data regularly collected and monitored from service screening programmes, with proper statistical analyses in addition to the results from the randomized trials. The authors of these articles set a precedent for how this could be done effectively.’ http://xa.yimg.com/kq/groups/14947167/193204470/name/benefits%20and%20%20harms%20of%20mammograms%202012.pdf

The time has come to move away from relying on randomized trials!

Once you move away from randomized trials you are no longer doing science. You are doing dogma. At which point the truth can never, ever, be obtained. When someone tells me we should use data regularly collected and monitored from service screening programmes with ‘proper’ statistical analysis – I know that THE TRUTH is being buried.

So long science.


To preventative medicine and beyond!

Preventative medicine has gone completely mad and it is only going to get worse. One of the most depressing articles I have read recently (and there was plenty of competition for this particular accolade) was in the Journal of Palliative medicine. It was entitled:

Statins in the last six months of life: A recognizable, life-limiting condition does not decrease their use.’

Statins, as you probably know, are used to reduce the risk of dying of heart disease, strokes and suchlike. Now, I am not exactly a fan of these drugs, to put it (very) mildly. But I thought that even the most fanatical ‘statinator’ might feel that if a patient is dying of terminal cancer, then there is little point in continuing with a drug designed to reduce the risk of heart disease.

Wrong. It seems that patients with terminal cancer are prescribed statins up until they draw their final breath on this Earth. What exactly are their doctors trying to prevent here? Well, at least they didn’t die of a heart attack first? Thank God for that.

I have had personal experience with this particular madness. I was visiting a lady of one hundred and one years old in a nursing home. The nursing staff asked me if I could change her statin from a tablet to a liquid form, as she was no longer able to swallow tablets. This lady was so severely demented that she could not speak, was unable to remotely recognise any of her relatives, and was lying immobile in her bed – doubly incontinent.

I felt that, in the circumstances, it was probably best just to stop the statin, especially as they are one hundred times more expensive in liquid than tablet form. So it all seemed like an expensive action in futility. For this action I was severely criticised by the nursing home, and another doctor involved in her care. I believe I was, at one point, accused of being ‘ageist.’ Well, I didn’t really know how to respond. I wondered where we drew the line with preventative medicine, and it appears we no longer draw the line, anywhere.

We carry on forever. We give drugs to the terminally ill, the extremely old and severely demented. Once started we never, ever, stop, no matter what, until the patient is dead. Perhaps at that point I should scatter statins on their ashes, just to make absolutely and completely certain that I am not missing a trick. After all, I would hate be thought of as ‘deadist’.