NHS Breast Screening Programme says
women should not be alarmed

The NHS Breast Screening Programme says women should not be alarmed at a repeated debate about the value of early breast screening trials.

The British Medical Journal and The Lancet are reporting on a decision by an expert panel for the USA's National Cancer Institute - the Physicians Data Query (PDQ) - to recommend that criticisms of the design of early Swedish trials are included on the NCI website.

The NHS Breast Screening Programme would like to respond with two points.

Firstly, the NCI has not committed to changing its website. The NCI has told the NHS Breast Screening Programme: "There has been nothing posted on our website because the NCI guideline has not changed due to the PDQ meeting. As you probably know, the PDQ is sponsored by the NCI but not part of the NCI. They are an expert panel. When they come out with a recommendation, possibly in April, the NCI will take it under advisement. Our guideline will not necessarily change in response to whatever the panel recommends."

"Furthermore, the NCI's Director of Cancer Prevention, Dr Peter Greenwald, has recently gone on the record in support of mammograms in response to this story: "NCI believes early detection is one of the most important approaches to cancer control. NCI recommends mammography for women starting in their 40s." (Reuters, 24.1.02).

Secondly, the NHS Breast Screening Programme is working with independent experts to review fully the evidence raised by Gøtzsche and Olsen. The International Agency for Research on Cancer (IARC) is producing a comprehensive review on screening for breast cancer, the results of which should be available in March 2002.

The NHS Breast Screening Programme would also like to draw attention to a new perspective on the screening debate detailed by Claudia Henschke and colleagues from Cornell Medical Center, New York, USA, who reviewed the Swedish trial previously reviewed by Gøtzsche and Olsen and concluded that reduction in breast cancer mortality is apparent after sufficient time has elapsed - around seven years - for the influence of successful screening and treatment to take effect. They state that the reduction in breast cancer mortality is substantial (55%) for women aged 55 years or older at entry to the study who were followed up 8-11 years after screening. (The Lancet 3.2.02).

Julietta Patnick, National Coordinator, NHS Breast Screening Programme, comments:

"At this point, we very much hope this academic debate will not undermine the life-saving work carried out every day across the UK in looking for, and finding, early breast cancers."

"It is right and proper that criticism of the screening system should be fully available in the public domain, such as on the NCI website, in the British Medical Journal or Lancet or anywhere else. The benefits as well as the risks needed to be considered. We are very encouraged by the findings of Cornell Medical Center, and believe we should be contributing our own positive evidence by the end of this decade."

Mrs Patnick added: "We will be watching what the NCI does very closely and with great interest. Until we see whether there is a redrafted statement on the NCI's website, we cannot make an informed comment."

"It would be very worrying if women's confidence in screening were to be undermined based on this re-assessment of trials that took place over 15 years ago, and even then showed positive benefit to women with breast cancer."

Statistics for NHS Breast Screening Programme 1999/2000:

• The programme has detected more cancers than ever before, 9,525 (6.39 per 1000) an increase of 8.6 per cent on 98/99.

• 4,041 invasive cancers smaller than 15mm were detected - an increase of 8.6 per cent on 1997/98. Cancers smaller than 15mm are usually impossible to feel with the human hand, therefore screening has found these cancers before they would normally be identified. Detecting these cancers through screening means that they will be treated earlier giving women a greater chance of survival.

• The vast majority of breast cancers (over 60 per cent) are diagnosed in women attending for a subsequent screen thus emphasising the importance of women accepting invitations for repeat screening.

• The number of women invited for screening (1,811,541) rose again this year in line with the expected increase in the numbers of women in the target age group. Acceptance (1,365,636) was steady amongst all women invited, as was the number of women recalled for assessment.