Harms from breast cancer screening outweigh benefits if death caused by treatment is included

Contact: Emma Dickinson edickinson@bmjgroup.com 44-020-738-36529 BMJ-British Medical Journal

Cancer expert remains to be convinced by breast screening review

Harms from breast cancer screening outweigh benefits if death caused by treatment is included

Michael Baum, Professor emeritus of surgery at University College London says that, while deaths from breast cancer may be avoided, any benefit will be more than outweighed by deaths due to the long term adverse effects of treatment.

He estimates that, for every 10, 000 women invited for screening, three to four breast cancer deaths are avoided at the cost of 2.72 to 9.25 deaths from the long term toxicity of radiotherapy.

These figures contrast with an independent report on breast cancer screening, led by Sir Michael Marmot and published in November last year. Marmot and his committee were charged with asking whether the screening programme should continue, and if so, what women should be told about the risks of overdiagnosis.

They concluded that screening should continue because it prevented 43 deaths from breast cancer for every 10,000 women invited for screening.

The downside was an estimated 19% rate of overdiagnosis: 129 of the 681 cancers detected in those 10,000 women would have done them no harm during their lifetime. However, those women would have undergone unnecessary treatment, including surgery, radiotherapy and chemotherapy.

But despite this higher than previous estimate of overdiagnosis, they concluded that the breast screening programme should continue.

The report also judged that screening reduces the risk of dying from breast cancer by 20%. But Professor Baum disputes these figures, saying the analysis takes no account of improvements in treatment since these trials were done, which will reduce the benefits of screening. Nor does it make use of more recent observational data.

With these data included, estimated rates of overdiagnosis as a result of screening increase to up to 50%, he argues.

This is important because it can change the decisions women make when invited for screening. In a study also published today, researchers at the University of Sydney explored attitudes to screening in a sample of 50 women. Many of the women were surprised when they were told about overdiagnosis and most said they would attend screening if overdiagnosis rates were 30% or lower, but a rate of 50% made most of them reconsider.

An accompanying editorial points out that the harms of screening will reduce as more effective diagnostic  processes develop to inform less harmful and more personalised treatments. In the meantime, it says women need up to date and transparent information about the benefits and harms of screening to help them make informed choices.

Life expectancy for poor white Americans drops sharply… but increases for blacks and Latinos: •White female high school drop-outs lived to 78.5 years in 1990, 73.5 years in 2008

  • White female high school drop-outs lived to  78.5 years in 1990, 73.5 years in 2008
  • Females who finished college lived for 83.9  years, males for 80.4
  • White males who didn’t finish high school  reached 70.5 years in 1990 and 67.5  2008
  • Black and Latino life expectancy rose,  regardless of education
  • The average Latin American life expectancy  rose 45 years from 29 in 1900, to 74 in 2010
  • American women are now 41st in the world  life expectancy league table
  • They were 14th in 1985

By Daniel Bates

PUBLISHED:10:39 EST, 21  September 2012| UPDATED:11:32 EST, 21 September 2012

 

Poor white Americans are seeing their life  expectancy decrease in trend that is close to what happened during the collapse  of the Soviet Union.

Researchers have found that white women who  did not finish high school saw the steepest decline and lost five years of their  lives between 1990 and 2008.

White men with a similar education died three  years earlier than they should have over the same period.

Worrying: The life expectancy for poor white Americans has dropped dramaticallyWorrying: The life expectancy for poor white Americans  has dropped dramatically

Worrying trend: Chart shows how the life expectancy of whites without a high school degree has fallen in recent yearsWorrying trend: Chart shows how the life expectancy of  whites without a high school degree has fallen in recent years

Black and Latino men and women, however, all  saw their life expectancy rise.

A similar study, presented by the Pan American Health Organization, found  that the average life expectancy in Latin  America has risen from 29 years in 1900 to 74 years in 2010, Fox News  Latino reported.

The researchers were appalled that in the US,  the richest country in the world, people were living shorter lives and said the  findings were ‘deeply troubling’.

 

Until now rising life expectancies have been  a given in the developed world and that decreases only happened in war-torn  African countries.

But a combination of unhealthy lifestyles,  obesity and prescription drug overdoses appear to be changing that.

The research found that a lack of education  was the key factor – white women who did not finish high school lived to 78.5  years in 1990 but just 73.5 years in 2008.

By comparison white women who finished  college lived for 83.9 years.

Men saw a drop from 70.5 to 67.5 years over  the same period but when you factor in education, the gap was even  bigger.

School's out: Those who did not finish high school saw the steepest decline in life expectancySchool’s out: Those who did not finish high school saw  the steepest decline in life expectancy

The researchers found that those who finished  college lived for 80.4 years respectively – 13 years more than their less  educated equivalents.

Lead researcher S. Jay Olshansky, a public  health professor at the University of Illinois at Chicago, said that such life  expectancies were on a par with those seen in America in the 1950s and  60.

And at the same time, black men and women- even if they had a poor education – saw their numbers steadily rise.

John Haaga, head of the Population and Social  Processes Branch of the National Institute on Aging, said: ‘We’re used to  looking at groups and complaining that their mortality rates haven’t improved  fast enough, but to actually go backward is deeply troubling’.

The decline has caused America to shoot down  the international league table of life expectancy, the New York  Times reported.

Unhealthy lifestyles: A rising number of obese people is partly to blame for the shift, researchers foundUnhealthy lifestyles: A rising number of obese people is  partly to blame for the shift, researchers found

According to the UN’s Human Mortality  Database, American women were 14th place in 1985 but were in 41st in  2012.

Among developed countries, American women  were bottom.

Michael Marmot, director of the Institute of  Health Equity in London, said that a five year decline in life expectancy was  like what happened in the former Soviet Union when it broke up.

Men lived seven years less on average than  they did before due to rampant alcoholism, high levels of smoking and a  healthcare system that had fallen apart.

Astonishing: A chart by the CDC shows the number of deaths per 100,000 people across the states in 2010 (NB not race-related)Astonishing: A chart by the CDC shows the number of  deaths per 100,000 people across the states in 2010 (NB not  race-related

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