Quintin Jardine's blog

I was 1) surprised, 2) bewildered, 3) annoyed 4) blazing angry this morning when I read a BBC report that the NHS in England is to review the evidence for breast cancer screening, following the publication of a questionable analysis into its efficacy by the Danish-based independent Nordic Cochrane Research Centre, and the publicly announced refusal by an academic of screening, on the grounds that she is concerned about the effects of over-diagnosis. I can only assume that Professor Susan Bewley believes that under-diagnosis would be better. She heads the department of complex obstetrics at King’s College, London, but I don’t find anything complex about the issues involved, and can only wonder why she’s trying to start a bandwagon rolling.

I’m going to declare an interest here. A few years ago, my wife went for a routine screening mammogram. It showed an anomaly, and she was asked to go back for further investigation. This revealed the presence of a very small tumour. It was removed almost immediately, there were no metastases, and, happily there’s been no recurrence. The incident was dealt with so effectively that when I happened to mention the subject in another context a few days ago, it took her a few seconds to recall that she was a cancer survivor herself.

If the screening programme wasn’t in place, that tiny tumour wouldn’t have been detected until it was a large tumour, her surgery would have been much more radical, and she’d have undergone debilitating and  destructive follow-up therapy. I don’t like to consider what the outcome might have been. Hers is just one case among thousands of success stories for the breast screening programme. Like every woman, she had the right to decline her mammogram. Professor Susan Bewley had that right and exercised it. But in my opinion, she does not have the right to use her academic position to undermine public confidence in the programme, if by doing so she might deter even a single woman from going for screening and thus allowing a treatable tumour to go undetected until it’s too late.

As for the Nordic Cochrane Research Centre, the brief research I’ve done on it myself makes me wonder whether it might be to general medicine what the Church of Scientology is to the treatment of mental illness. It can play with numbers all it likes, but it can’t be allowed to play with lives. Any time spent by the NHS reviewing its allegations will be time wasted. Time is money. If that money is available, it should be invested in enhancing existing screening, not questioning it.