UK's breast cancer screening programme reviewed

In collaboration with the Press Association

The UK's National Cancer Director, Professor Sir Mike Richards, has ordered an independent review of the NHS breast cancer screening programme.

Professor Richards told the British Medical Journal (BMJ) that the review was intended to resolve "the ongoing controversy" over breast screening.

Concerns were heightened by an open letter from Professor Susan Bewley, consultant obstetrician at King's College London, which suggested the potentially harmful consequences of breast screening were not communicated clearly enough, and that screening information should be more balanced.

Professor Bewley said she believed that NHS leaflets "exaggerated benefits and did not spell out the risks".

She wrote: "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."

She pointed to evidence from the Nordic Cochrane Centre suggesting that screening information should be more balanced.

In reply, Professor Richards pointed to the evidence, published by (pdf) the World Health Organisation (WHO) in 2002, confirming that breast screening saved lives, and to evidence (pdf) provided by the independent Advisory Committee on Breast Cancer Screening (ACBCS) .

"[The WHO] concluded that screening women aged 50-69 years old reduced mortality by 35 per cent. On the basis of the experience of breast screening in England, the ACBCS estimated that for every 400 women screened regularly over a 10 year period, one woman fewer will die from breast cancer than had they not been screened," he wrote.

However, he accepted that the "controversy should, if at all possible, be resolved".

He confirmed he has initiated an independent review of the research evidence, jointly led by Cancer Research UK, and that a new process for developing written information for the public about each screening programme is also being established.

Professor Richards promised the breast screening leaflet will be one of the first things to be revised through this new process. "I hope this reassures you that I take the current controversy very seriously," he concluded.

Sara Hiom, director of information at Cancer Research UK, agreed that the review was needed.

"An independent review of the evidence, both of the number of lives saved and the level of 'over-diagnosis' by the breast cancer screening programme is needed and Cancer Research UK is working with the National Cancer Director to achieve this, " she said.

"Independent experts will be leading the review and we will then host a workshop to discuss the findings, inviting representatives from both sides of the argument. We mustn't lose sight of the fact that the fundamental principle underpinning screening - that earlier diagnosis helps improve outcomes - is right and that screening does help save lives".

She went on to point out that the other screening programmes available in the UK were not being questioned. "This is not a review of all screening programmes - the evidence for bowel and cervical screening is unequivocal, they will save thousands of lives every year. "

However, she agreed that the debate should be settled "objectively, transparently and as swiftly as possible".

"Women need more accurate, evidence-based and clear information to be able to make an informed choice about breast screening. The decision whether to be screened is a personal one, but that decision should be made with all of the potential harms and benefits fully explained, " she concluded.

Professor Julietta Patnick, Director of the NHS Cancer Screening Programmes, also welcomed the review. "The NHS Breast Screening Programme has always been based on the best and latest evidence. To ensure this, the Programme has been regularly reviewed over the more than 20 years that is has been running.

"In that time, where new information has suggested them, a number of changes have been made to the Programme, for example extending the screening age range and using digital mammography. We look forward to the findings of this latest review."

Copyright Press Association 2011