Practitioners should not be incentivised to achieve participation, nor should high participation in screening be regarded as a marker of health service quality.
|Scooped by Graham Player Ph.D.|
The British Medical Journal has published a report by Dr. Alexandra Barratt, Professor of Public Health in the School of Public Health, University of Sydney which debates the case of over-diagnosis in breast cancer mammography screening.
It was thought that the benefits of early detection and treatment would outweigh any risks of treatment and would not introduce substantial harm through false positives, radiation, or over-diagnosis. However, evidence of the unanticipated harms of mammography screening has fuelled debate about whether such screening should be changed or even abandoned. In Switzerland routine mammograms have been discontinued, as The Swiss Medical Board have stated the benefits of mammograms do not outweigh the harms.
In an optimal screening scenario rates of advanced cancer should drop with increased detection and treatment of early stage disease. However this appears not to be the case, as many studies show that rates of advanced breast cancer have declined only modestly or remained stable. This strongly suggests that mammography screening is detecting low risk or non-progressing breast cancer that would never have become life threatening.
Screen detected breast cancer that is non-progressing cannot be distinguished from early cancer that will progress because of the lack of reliable prognostic markers. As a result treatment is recommended to all women to reduce the risks of recurrence and breast cancer mortality, and they are all exposed to the physical and psychosocial harms of cancer treatments even though the cancer detected may never have progressed, or indeed it may have gone away of itself.
Many women continue to be “prescribed” or encouraged to undergo screening rather than being supported to make an informed choice. Women should be given complete and unbiased information that has been carefully developed and tested. Information is an intervention that may have both positive and detrimental effects if it is not complete and unbiased.
In addition Dr. Barratt asserts that practitioners should not be incentivized to achieve screening participation, nor should high participation in screening be regarded as a marker of health service quality.