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Should breast cancer screening be routinely offered to women aged over 70? For that matter, is routine breast screening desirable anyway? These questions are the subject of an important new BMJ article by Susan Bewley and colleagues (BMJ 2019;364:!1293).
In 2009 Public Health England began recruiting millions of women to the Age Extension Trial of Breast Cancer Screening (AgeX). The trial has been criticised for its design, conduct, and lack of transparent scientific processes. which may render it not robust enough to inform policy decisions. Even more serious, “Participants’ understanding and consent to participate in research are not checked despite the risks of surgical and psychological harm.”
At the common-sense level screening for cancer looks like a stupide question to many people. The earlier it’s caught, the better the chance of a cure, right? Well, that is debatable, at least for breast cancer. Many breasr cancers, particularly in older women, would never cause them any problems during their natuurl life span, so treating them will involve them in unnecessary surgery and quite probably inflict psychlogical harm that will last for the rest of their lives.
The balance of benefits and harms from breast cancer screening remain contested. Three years after Age X began, an architect of the breast cancer screening programmes argued that deaths after treatment of screen diagnosed breast cancer may exceed those in an unscreened population. In 2014. the Swiss medical board advised its government to stop recommending mammography screening. In 2016, an open letter from French scientists who had conducted a consultation into France’s breast cancer screening called for a halt to screening for low risk women under 50, and an end or thorough review of the programme for women over 50.
This is reminiscent of the question of PSA screening for prostate cancer in men.