Over the past week, Croakey has been hosting a lively discussion about the merits of breast cancer screening, in the wake of new research highlighting the potential for over-diagnosis and unnecessary treatment. You can read some of the previous pieces here, here and here.
Now Daphne Havercroft, a Founder Member of an advocacy organisation for patients in the UK, called Independent Cancer Patients’ Voice (ICPV), offers her perspective, arguing that women should be given balanced, accurate information, and their personal choices about whether to be screened, or not, should be respected.
“ICPV doesn’t have a united view on breast screening. Our members have various views.
But we are united in agreeing that women should have fair and balanced information to make an informed choice about whether or not to be screened. If they choose not to be screened, they should not be made to feel that it is an irresponsible decision, as sometimes seems to be the case.
We welcome the work being done in the UK by Dr Joan Austoker of Oxford University to rewrite the information leaflet sent to women with Breast Screening appointments so that they are told the truth about what is known of the benefits and harms of breast screening. Three of us recently met Dr Austoker and realised what a difficult job she has, because whatever she produces will not please everyone.
It is now well accepted that breast screening will lead to over-treatment for some women. The controversy concerns the statistics about the extent of harms versus benefits.
We hear views from women who have been diagnosed with breast cancer varying from those who are outraged that they may have had unnecessary treatment to those who are convinced their lives were saved by breast screening. The problem is that neither these women nor their doctors can say with absolute certainty whether the treatment was appropriate or whether they were over-treated.
It is unethical for any woman, whether or not she has had breast cancer, to use her views and personal experiences to influence other women as to whether or not to be screened.
That is a decision each woman is entitled to make for herself.
It’s time to move on. ICPV wants to see all women provided with fair and balanced information about breast screening. It must be based on the best available evidence, and be honest about the differing views of experts.
We have a great opportunity to bring a multidisciplinary approach to the future of breast screening by bringing together epidemiologists, breast clinicians, public health experts, researchers, psychologists, cancer patients and women of screening age to understand what we currently know about the biology of breast cancer, what we need to know to better distinguish between disease that will do not harm if left and that which will kill.
Then we must decide on the research priorities that will reduce the incidence of over-treatment, yet not lead to under-treatment. If we make good progress, breast screening information for women will rapidly become out of date and have to be revised every few years as knowledge increases.
Let’s start this work now, for the sake of future generations of women.”