Efficacy of cancer screening called into question


NHS screening programmes \'do more harm than good\' according to leading GP

Screening for health conditions such as breast cancer should be scrapped in order to save the NHS money, according to Clare Gerada, chairman of the Council of the Royal College of General Practitioners (RCGP).

The controversial comments were made at the first nhsmanagers.net Health Chat event in London last Thursday.

She said: “Most people do not need health checks. Most of the screening we do is a waste of time. Certainly there is a lot of evidence to say that breast cancer screening is a waste of time. The evidence is that it means people know they have breast cancer earlier rather than it helping them to live longer.

“We have only known since the 1980s that screening doesn’t work and a lot of brave people have come out and said it, but they have been shot down.

“The trouble is there is a lot of money in screening and a lot of emotion. It is something we take for granted, but is it a waste of money?

“Most people need nothing more than basic healthcare, but we are so used to it. Going forward we have to start thinking about that. There are fewer GPs per head of population than we have ever had before and there is an expanding population and to deliver these sorts of services going forward is probably impossible.”

Her comments have widespread support. Professor Peter Gøtzsche, director of the Cochrane Collaboration, recently called for breast cancer screening to be stopped.

He said: “I don’t think screening has any effect on breast cancer mortality, but it does lead to harm and many healthy women get a cancer diagnosis that doesn’t help them. For every life saved, a further 10 are harmed.

"I believe the time has come to realise that breast cancer screening programmes can no longer be justified. I recommend women to do nothing apart from attending a doctor if they notice anything themselves."

And this week a study by the London School of Hygiene and Tropical Medicine and University College London claimed that tests for prostate cancer may be incorrectly giving the all-clear to up to 50% of men who actually have the disease.

Experts believe thousands of patients are missed every year because the standard biopsy techniques used at most NHS hospitals are flawed.

And thousands more perfectly healthy people could be wrongly diagnosed with the disease and undergoing needless radiotherapy or surgery.

But screening services were defended by Professor Julietta Patnick, director of the NHS cancer screening programmes. She said: "Here in England we know that the best evidence available shows that women aged 50-69 who are regularly screened are less likely to die from breast cancer."

She cited an estimate from the International Agency for Research on Cancer (IARC) of the World Health Organization which said mortality was reduced by 35% through screening — a figure Gøtzsche disputes.

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At the meeting last week, Gerada said: “There is some evidence that screening for bowel cancer does have a positive effect, but I would argue that the NHS can no longer continue offering other screening services.”