Cancer checks 'have little impact' (News Article)

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Breast cancer screening has had little impact on falling death rates from the disease, according to new research.

Experts compared data from three pairs of European countries and found the countries within each pair experienced a similar fall in death rates.

This was despite a gap of 10 to 15 years between the countries in implementing a breast cancer screening programme.

Northern Ireland was compared with the Republic of Ireland, while the Netherlands was compared with Belgium, and Sweden with Norway.

From 1989 to 2006, deaths from breast cancer decreased by 29% in Northern Ireland and by 26% in the Republic of Ireland, according to the study, published in the British Medical Journal. Deaths also fell by 25% in the Netherlands and by 20% in Belgium and 25% in Flanders. Sweden deaths were down 16% compared to 24% in Norway.

The researchers, who analysed data on deaths from the World Health Organisation database, concluded: “Countries of each pair had similar healthcare services and prevalence of risk factors for breast cancer mortality but differing implementation of mammography screening, with a gap of about 10 to 15 years. The contrast between the time differences in implementation of mammography screening and the similarity in reductions in mortality between the country pairs suggest that screening did not play a direct part in the reductions in breast cancer mortality.”

The study was led by a team of researchers from France, the UK and Norway. They suggested better treatments and improving health systems were more likely to have contributed to falling death rates than screening.

Breast Cancer Care’s clinical nurse specialist, Rachel Rawson, said: “Though this retrospective study comparing breast cancer mortality using three country pairs is interesting it may not take into account all of the factors that might have influenced the results. In the UK breast cancer mortality rates have fallen year on year since 1989. This reduction is likely to be due to various causes including screening, improved treatment regimes and increased specialisation of care. Breast screening remains an effective option for detecting breast cancers as soon as possible.”

Professor Julietta Patnick, director of the NHS Cancer Screening Programmes, said: “The World Health Organisation’s International Agency for Research on Cancer estimates that there is a 35% reduction in mortality from breast cancer among screened women aged 50 to 69 years old; and in England, the independent Advisory Committee on Breast Cancer Screening estimates breast screening saves 1,400 lives each year.”

A spokeswoman for the Department of Health said: “According to the vast majority of experts, the evidence shows that breast screening reduces deaths from breast cancer. The NHS Breast Screening programme is based on the best available evidence and in line with the recommendations of the World Health Organisation. Experts estimate that the NHS Breast Screening programme saves the lives of 1,400 women each year and we are extending it to ensure that every eligible woman should receive her first invitation by her 50th birthday.”

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Despite the headlines, it seems that the report is really saying that screening doesn’t have much impact before 50. The BBC version includes this:

'Breast cancer death rates varied little between countries where women had been screened by mammography for a considerable time compared with those where women were largely unscreened during that same period, say the authors.

And the greatest reductions were in women aged 40-49, regardless of the availability of screening in this age group, they said.’

I’m one of those whose cancer (DCIS) was symptom-free when picked up by screening (at 60) and a second time (IDC) during a follow-up checkup.

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Yes I am as well. I was having family history mammograms, and my DCIS was picked up on the last one. My DCIS area was nearly five cms (three small invasive tumours too), so must have grown quite quickly, as there was no trace the year before. If I had not had this mammogram I would have certainly be a “walking timebomb”.

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It strikes me as something else that can be used to hold off giving mammograms to younger women!

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Mine was found at a routine mammo at a time when the lump wasnt palpable at all.

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Well cancer checks had a definite impact on me. At my routine mammogram last October I discovered that I had IDC in my left breast and ILC in my right even though there was nothing that could be felt in either. After WLE it was discovered that both lumps were bigger than originally thought and that there were two more in my left as well as other areas of suspect tissue - and of course no clear margins. Bilateral mastectomy followed in December.
I am not sure what is the point of the article

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Another scare mongering article - I had DCIS, two lummps and pre
cancerous cells resulting in a masectomy. I was asked why I had
not had a mammogram for some years and replied that at that time
the procedure was stopped when you reached a certain age. When I
had the mammogram it was because the age had been extended and
therefore I was very lucky that it was caught in time.
I am sure the people who write these articles and do the research
do not take account of the situation where no lump is found therefore
no warning is received.

Pat

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Three things to say about this:
(1) What a coincidence that researchers suggest breast screeening hasn’t contibuted to improved survival, just as governments in Europe are looking to make savings and cut back on public spending.
(2) the phrase ‘screening did not have a direct part in reductions in breast cancer mortality’, is revealing. Screening is actually about prevention and so works in ways that are not quantifiable.
(3) The largest improvement was amongst people under the age of 50 years old, and as these people are not routinely screened then of course survival was not down to screening in this group.

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The article is not about younger women. It is about breast cancer screening programmes which are mostly for 50-70s. What it said about younger people was - younger people not invited to screening have the same reduction in mortality from breast cancer as those in the screening age group. Meaning that the reduction in mortality in the older group is not due to screening, but to the same things that are reducing mortality in the younger group, i.e. better treatments, infrastructure (which is there because of screening) and awareness.

Screening is not about prevention, it does not prevent breast cancer, it only finds cancers which are already there. It aims to find them at an early stage of development, on the belief that the prospect of survival is better. The study says these comparisons show that early detection is not making a difference to survival. i.e. finding it early doesn’t make people live longer.

It isn’t the first study to show this. Others do. One I found dated 1998. The people who conducted this research are nothing to do with the government and not likely to be wanting to support spending cuts, and if they were, that would not be a legitimate motivation for a scientific study.

So what they are saying is that it isn’t true that we’re lucky our DCIS was found, because it isn’t making any difference to survival to have it treated when found at screening; if we hadn’t gone to screening we either would never have got cancer, or would later have found a symptom and if treated would survive just as long after as we’re going to now, I mean, to die at the same time, so having it treated now instead of later isn’t helping, is what they are saying.

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That might be what they are saying. However, if I hadn’t gone for screening I may have been sitting here sitting here with two more breasts than I have at the moment but God alone knows how big the lumps they found would be nearly a year down the line. Then there were the smaller lumps and suspicious cells they found after wle. My nodes might have started kicking in to halt spread by now. Yes I may have survived just as well but I am very glad that I avoided the more aggressive treatment which might have been required if I had to wait until the lumps were felt. I would probably have had the mastectomies eventually but mammogram screening may have saved the NHS the cost of radiotherapy and chemo.

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I’m interested in your analysis Snowwhite which seems to cut thro’ some of the confused thinking on this topic. Also in your comment yamslass- but how old are you?
Did you or anyone else hear the discussion on screening on yesterday’s Woman’s Hour?

‘Horace’ is the only person I can recall on these forums who had her BC picked up, like mine, on a routine mammo when she (and I) were otherwise a-symptomatic- no palpable lump, no nothing. Both of us were found to have BC though I think hers was also triple neg which is unusual I believe in we ‘older’ women’(we’re both in our 60s)

I escaped mxt even though I was Grade 3 Stage 3; had WLE and full clearance plus chemo and rads. so I guess I am exactly the sort of patient whose prognosis has been improved by screening- we shall never know how long it would have been before other symptoms would have appeared - but in our case we KNOW that they would have done.

I have asked (in vain) if anyone has any stats on the number of people like Horace and me who had well established BC but were symptomless when picked up by mammo. Everyone else I have ever heard of who was diagnosed by mammo either had DCIS - or if they did have BC, they already had other signs and symptoms & would have gone for investigation anyway

Clearly screening remains very controversial; it is hugely expensive & may well be gross over-treatment for many wpmen. I, for one, do not find the case proven- despite my own "lucky’ detection.

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Topsymo, I was 64 at diagnosis. I had no other symptoms apart from a bit of discomfort in my breasts which I had had for several years - certainly before the previous mammogram. I did not bother mentioning this to anyone because of the widely held belief that this was not a sign of cancer. I didn’t hear the Women’s Hour discussion

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I was 55 at diagnosis over 4 years ago. The invasive cancer was found during routine screening and was not palpable as it was very deep. It was grade 3, ER, PR and HER positive and described as very aggressive. It was bigger than they thought at 12mm (so small anyway) with no spread to the nodes or vascular invasion. There was also high grade DCIS which was occult on the mammogram so only discovered when the tissue was analysed. I had a WLE, chemo, rads, Herceptin and I am now on Aromasin. Most others I know who were diagnosed due to routine screening had less aggressive cancer - but there is no doubt in my mind that had I not been screened, the chances of spread to the nodes or organs would have been higher by the time the lump was noticeable.
All the best
Anne

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Topsymo I too was picked up by routine screening with no other symptoms. It was my third mammogram ( I was 57 at the time). I was found to have four lumps ( only one picked up by screening) none could be felt and I had wire guided wle followed two weeks later by mx. I am thankful that this was picked up when it was as nodes were still clear and have had chemo and rads and now on arimidex. Pam x

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My cancer was picked up by a routine mammogram too. Not a sign of a lump, bump or dimple anywhere, so I’m very grateful for the screening programme.

AlexG

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I was 52 at diagnosis - my first ever screening, and I had no symptoms that could be defined at all. I have always checked my breasts regularly (my mother was diagnosed with breast cancer at 50 with a very large invasive lump, misdiagnosed for at least a year previously), and nothing could be felt.
I have IDC, 2 cm, with spread to lymph nodes - I have no doubt that screening picking this up when it did has made a big difference to my prognosis, heaven knows how much further it would have spread before I found it myself. As it is I have had WLE, full ax clearnance, 7 months of chemo to be followed by rads and tamoxifen. I don’t think the oncologist is recommending all of this without good cause.

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Hi

I am another oldie having been diagnosed at routine mammogram. No signs or symptoms of anything sinister before. I am 63. I am grateful that it was picked up. I think mammograms are good and help prevent deaths by picking up the BC before it gets any bigger and at an early stage. Soon, women will be treated with medicine/injections to prevent cancer from forming in the first place. I dont think the cure will come yet, but the preventative measures will. chris x

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There is no doubt that routine screening does detect some cancers but I am 51, had a routine screening which was problematic, so had another a month later. Nothing was found. Four months after that I found a lump which was only seen on ultrasound … it was 6 cm with margins and I had to have a mastectomy. What I’m saying is mammograms don’t detect all cancers … so maybe we need other types of screening as well as the mammogram?

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I agree. I have MRI scans now as well as mammograms because the DCIS was mammographically occult. However some people aren’t keen on MRIs as there can be many false positives as they pick up so much detail.
Anne

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I am really interested in all the responses to my comments: at least I have now heard of one or two other people who were detected by routine screening but who, like myself had no signs or symptoms or history etc - - though we are hardly statistically significant are we?!

I would really like to see some study figures (they must exist) as to how many people, detected by routine screening, have received treatment for DCIS alone: this info obviously exists but I haven’t been able to find it in any of the info that I have looked at. Can anyone help me on this?

On a linked point- I understand that some professionals think BC screening should be much more selective - in which case I don’t think I would have fallen into the selected group- as I have no family history and had never had any lumps or breast probs of any sort previously