The Breast Screening Debate in Perspective

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Q. I‘ve just received an ‘invitation’ for breast screening but am confused about whether to go as there has been some adverse publicity. Can you advise?

A. In the UK, women between 50 and 70, without symptoms, are offered breast screening (mammography) every three years. But as of now, there is no clear advice to give you about the risks and benefits. However, an independent review of all the evidence for and against breast screening (mammography), led by Professor Sir Mike Richards, National Cancer Director, will report this year. Meanwhile I can explain the main issues.

The key question is whether breast-screening causes more harm than good. While the NHS leaflet on breast screening states ‘regular screening prevents deaths from breast cancer’, many experts say this is misleading and that women are not given all the relevant information. A recent review of 100,000 women over 50 by researchers at Southampton University supports previous evidence that many are treated unnecessarily.

The main problem is over-diagnosis due to false positive results and overtreatment of harmless lumps (see below).
The Nordic Cochrane Centre in Copenhagen estimates that over-diagnosis ‘results in 30 per cent more surgery, 20 per cent more mastectomies, and more use of radiotherapy’. The Southampton review estimates that for every woman whose life is saved by screening, ten go through unnecessary treatment. And in about 20 per cent of cases, a mammogram gives normal results but the woman actually has breast cancer(false-negative results).

The lumps that could be harmless are called ductal carcinomas in situ (DCIS).
DCIS is the earliest form of breast cancer. It is non-invasive and is not life-threatening. The argument is whether or not DCIS should be treated. In September 2010, Robin Wilson, consultant radiologist at the Royal Marsden Hospital and a proponent of screening, admitted it’s ‘inevitable that some screen-detected cancers may have never progressed to threaten life’. Professor Michael Baum, a critic of the current screening programme, says the system needs to be fine-tuned to assess risk more accurately.

Deaths from breast cancer are declining but not due to screening. A British study showed the decline in mortality from 1989 to 2007 was the same among women who were screened and those who were not,

Further information. Professor Peter Gotszche and his team at the Nordic Cochrane Centre have written a comprehensive leaflet (screening.dk). While official advice here is that women between 50 and 70 should attend screenings, he says that it is reasonable to opt for screening, but it is also reasonable not to.

A Savvy Way to Keep Supple

 

I’ve received several fan e-mails for the Superior Joints supplement. As well as natural anti-inflammatory compounds (including ginger, turmeric and tart cherries), it contains natural eggshell membrane (NEM), which has been clinically proven to reduce joint pain and stiffness without side effects. In a trial published in JCR: Journal of Clinical Rheumatology, more than half of patients with knee osteoarthritis recorded an improvement within ten days. I take it (for hips and lower back) and can testify to its effectiveness. Superior Joints, £29.95 for 60 capsules (two a day), from Victoria Health.

A Choccy (or two) A Day

When your beloved gives you a gift of delicious (dark) chocolate on Valentine’s Day, the good news is you can indulge with a clean conscience. As nutritionist Zoe Harcombe says, ‘100g a day of dark chocolate is a terrific source of minerals.’ It also contains polyphenols (antioxidants also found in red wine and green tea), plus flavonoids, which help blood flow. Recent research shows that eating a little dark chocolate daily can help reduce your risk of stroke and heart attack. And if you like your choccy spiced up, try dark chocolate with heart-warming ginger such as Prestat Choxi+ Dark Choc with Ginger (a four bar stack for £7.99, prestat.co.uk) or Organic Fairtrade Double Ginger Fine Dark Chocolate Bar by the Seed & Bean Company, (200g for £7.49, seedandbean.co.uk).

3 of the Best: Fitness Apps

 

iMapMyRun/iMapMyRide (basic version free, or +version £1.49): Enables you to track your runs, cycles or walks – you can record duration, distance, pace, speed, elevation, calories burned, plus your route on an interactive map. ‘Brilliant! Really useful and quite addictive,’ says our tester, a keen runner.

MyFitnessPal (free): You set a daily calorie goal, then record what you eat and how much you exercise. Usefully, it remembers all your favourite foods, and even has a bar code scanner. It also tracks your weight and measurements. YOU tester says: ‘Very easy to use and great for motivation.’

Yoga Journal iPractice (£1.99): 15 yoga sequences of ten poses each, with illustration and audio. You select the level, desired effect, eg calming, strengthening, immune boosting, and length of time in each pose. YOU tester says: ‘High quality, as you would expect from the leading yoga magazine.’

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