KeepHealthCare.ORG – Targeted breast screening progamme for ‘high-risk’ women could ‘greatly reduce overdiagnosis’, researchers say
Scrapping the NHS universal breast screening programme and replacing it with a system targeted at higher-risk women could do “more good than harm”, researchers said today.
They said it could dramatically reduce the risk of overdiagnosis — where women undergo treatment, often surgery, not necessary to ensure their survival — and save the NHS cash.
At present, women aged 50-69 are invited to have a mammogram every three years to check for breast cancer.
The study led by University College London, in the journal JAMA Oncology, found that excluding “low-risk” women from screening would make the whole process more effective.
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Lead author Dr Nora Pashayan, from UCL’s Department of Applied Health Research, said: “Breast screening has both benefits and harms: it can reduce [the rate of] death from breast cancer in some women while others may have unnecessary diagnosis and treatment of breast cancer.
“Offering screening according to women’s risk level could improve the efficiency of the screening programme and reduce its harms.”
Studies have shown the risk of developing breast cancer varies significantly among women, especially with age. Genetic, lifestyle and reproductive factors also affect susceptibility.
In May, it was revealed that a Public Health England computer blunder meant 450,000 women aged about 70 had not been called for their final mammogram. This was later reduced, after checks, to 174,000 women affected — of whom 130,000 are still alive.
Jeremy Hunt said “less than 75” women have died prematurely because they hadn’t been called to their final mammogram
It was initially thought that between 135 and 270 women may have died prematurely but this was later reduced by Health Secretary Jeremy Hunt to “less than 75”.
The research studied three hypothetical cohorts of 364,500 women, aged 50 and free of cancer, over 35 years. The first group received no screening. The second received a mammogram at age 50, and every three years thereafter. In the third group, those with a low risk of breast cancer were not offered the scans.
This estimated that, in a system based on risk-targeted screening, if mammograms are not offered to the 30 per cent of women at the lowest risk, there could be 27 per cent fewer overdiagnoses, three per cent fewer breast cancer deaths and a £20,000 saving.
By screening only the 30 per cent of women at highest risk, there could be 71 per cent fewer overdiagnoses, 10 per cent fewer breast cancer deaths and a £538,000 saving to the NHS.
Dr Pashayan said: “The take-up of breast screening is currently around 72 per cent. If we maintain this take-up but in a way that women who would benefit more from screening attend and women who would be more harmed from screening are spared, then the cost-effectiveness and benefit-to-harm balance of the NHS breast screening programme could be improved.”