BREAST SCREENING
Breast cancer screening – an informed choice? Antonia Wrigley GP; JHH editorial board member
The advice women are given about the pros and cons of breast screening can be misinformed, and distorted by vested interest and bias. Women need to feel empowered to take control of their own health
As an NHS GP I have been following the overdiagnosis movement over the last few years. I also have a growing (and somewhat conflicting) interest in lifestyle and functional medicine. Having recently finished my GP training I am well versed in evidence based medicine and informed choice, both of which are noble ideals that I agree with in principle. In practice, however, it can be extremely difficult to deliver. On the one hand the ‘evidence’ is far from robust, and on the other not all patients have the resources or motivation to take control of their own health and make what can be complex decisions.
‘The central idea of early disease detection and treatment is essentially simple. However, the path to its successful achievement (on the one hand, bringing to treatment those with previously undetected disease, and, on the other, avoiding harm to those persons not in need of treatment) is far from simple though sometimes it may appear deceptively easy.’
These issues not only make decisions about screening far from straightforward, but also ensure that evaluating screening programmes will be difficult.
Synthesis of emerging screening criteria proposed over the past 40 years • The screening programme should respond to a recognised need. • The objectives of screening should be defined at the outset.
Andermann et al (2008)
with reliable information
Introduction
• There should be a defined target population.
and choice. Detecting signs
Screening makes sense to health professionals and patients/laypeople alike. It intuitively feels like a good thing to do. If we catch something early we should be able to fix it before it causes problems. It saves lives, which is surely worth the minimal harms and the cost. Well yes; but only if it is a truly effective screening test and appropriately used. A perfect screening test would positively identify everyone who has early disease, without falsely identifying anyone who is unlikely to get the disease. But identifying this precise group is only going to be worth the effort if there are treatments available which are more effective in the early stages of the disease than they would be later on. Also, the test itself should not cause any harm.
• There should be scientific evidence of screening programme effectiveness.
of disease early is a good thing as long as investigations are not harmful and treatment options are likely to improve health and wellbeing. Because diet and exercise can reduce cancer risk, a ‘diagnosis’ or scare can be an opportunity for change to a healthier lifestyle.
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• The programme should integrate education, testing, clinical services and programme management. • There should be quality assurance, with mechanisms to minimise potential risks of screening. • The programme should ensure informed choice, confidentiality and respect for autonomy. • The programme should promote equity and access to screening for the entire target population. • Programme evaluation should be planned from the outset. • The overall benefits of screening should outweigh the harm. (Andermann et al 2008)
© Journal of holistic healthcare
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Volume 14 Issue 2 Summer 2017
