Breast screening may do nothing to save lives, says global study

British cancer charities were fighting to encourage women to continue having breaast scans after a controversial report claimed that teh scans were a waste of time and that they didn't save lives.

British cancer charities were fighting to encourage women to continue having breaast scans after a controversial report claimed that teh scans were a waste of time and that they didn't save lives.

More than 1.2 million women are screened for breast cancer in Britain each year at a cost of £36m. Almost 8,000 cancers were detected in 1997-98, of which 3,400 were too small to be felt with the human hand.

But Danish researchers who examined results from eight trials carried out around the world found that women who had regular breast screening did not have a significantly reduced death rate compared with those who were not screened.

The controversial study, published in The Lancet, follows earlier research in Sweden, which showed no reduction in deaths from breast cancer since the nationwide screening programme was introduced there in 1985.

That finding runs counter to the views of most British specialists who believe the UK screening programme, launched in 1988, has contributed to the sharp fall in breast cancer deaths.

The NHS Breast Screening Programme said: "We strongly urge that the benefits of screening are not dismissed on the basis of these comments in The Lancet.

"The interpretation and methodology applied in the paper itself is open to question. The UK National Screening Programme remains confident of its clear and significant achievements to date, and will continually strive to provide women with the best possible level of service."

Delyth Morgan, chief executive of the charity Breakthrough Breast Cancer, said: Ã’This report is not a positive contribution to the debate into the effectiveness of breast screening programmes. We must not be deterred from continuing our screening programmes until we have seen categorically that they are ineffective.

ÒOur expectation in the UK is that this is not the case. What we should be debating is how best to screen women.ÓShe said more than 7,000 cases of breast cancer are found by the NHS Screening Programme every year and argued that the service should be extended to older women.

In Nottingham, deaths from breast cancer among women aged 50 to 69 fell 32 per cent between 1990 and 1996. The Danish researchers, from the Nordic Cochrane Centre in Copenhagen, found that six of the trials, conducted in Edinburgh, New York and areas of Sweden, suggested that breast screening cut the death rate from breast cancer by 25 per cent. But the overall death rate from any cause showed a slight increase. These trials did not have strictly comparable groups of women. The two trials that were strictly controlled - carried out in Canada and Malmo, Sweden, - showed no reduction in the death rate from breast cancer.

The authors conclude that those who believe the six less strictly controlled trials are valid "have to accept from the data that screening with mammography causes more deaths than it saves". If they reject those trials as invalid, then they must accept there is no good evidence that breast screening is worthwhile since the two remaining trials showed no reduction in deaths.

In a commentary published with the study, Dr Harry de Koning of the Rotterdam department of public health in the Netherlands says the researchers have ignored the fact that "other factors probably have a more important part in lowering the mortality rate through screening".

In Holland, deaths from breast cancer among women age 60 to 69 are now falling, but the decline did not start until nine years after breast cancer was introduced.

The NHS Breast Screening Programme said: "We strongly urge that the benefits of screening are not dismissed on the basis of these comments in The Lancet.

"The interpretation and methodology applied in the paper itself is open to question. The UK National Screening Programme remains confident of its clear and significant achievements to date, and will continually strive to provide women with the best possible level of service."