BRITAIN'S #100m programme to screen women for cervical cancer was
founded on a ''mistake'' that must never be repeated, a team of
researchers claims in a report.
Its introduction 30 years ago was unevaluated. Now one in 10 young
women are falsely classified at risk after ''abnormal'' smear tests.
Thousands face the worry of possible cancer and some are treated for a
condition which they may never have, according to the team from Avon
Health Authority and Southmead hospital, Bristol.
It carried out a detailed study of detection rates in around 226,000
women in the Bristol screening programme. Despite a high uptake of
tests, it found that the expected eradication of 30 to 40 city deaths a
year had not materialised. The effect of screening on death rates was
too small to detect.
Now that screening was widespread, it concludes: ''We must simply face
the fact that we can never know for certain how much contribution
screening has made.''
The study by doctors Angela Raffle, Brian Alden, and Elizabeth
Mackenzie is reported in a leading article in the Lancet. Dr Mackenzie
was formerly director of the Bristol programme.
When screening was introduced nationally in 1966, cervical cancer was
associated with abnormal cells in smears. ''But the prevalence and
incidence of the abnormal cells on smears and the effectiveness, in
terms of mortality reduction, of finding and treating women with
abnormal cells has not been established,'' the study concludes.
As pressure for increased screening and revised methods grows for both
cervical and other cancers, it warns: ''It is essential that the
limitations of screening for cancer are sufficiently appreciated within
the medical profession and among the wider public to ensure that the
mistake of introducing an unevaluated screening programme will never
happen again.''
It finds ''encouraging'' the decline in national death rates -- down
to around 1660 from 2088 15 years ago. Much of that decline was
attributable to older women who had not been screened, it says.
It points out that, in each Bristol screening round, about 15,000
healthy women were being incorrectly told they were ''at risk'' and more
than 5500 were being further examined, with many also being treated.
Each round covers a five-year period.
''The real lesson from 30 years' cervical screening is that, no matter
how obvious the predicted benefit may seem for any screening test,
introduction should never take place without prior evaluation of both
positive and negative effects in controlled trials.''
In a statement concerning the Bristol study, the NHS Cervical
Screening Programme said cervical cancer was the most common cause of
death in women under 35.
It added: ''The women who are most at risk -- older women and those in
inner cities -- are now starting to reap the benefits of the improved
programme and the death rate among younger women is also starting to
fall.
''The evidence available clearly points to the benefits of the
screening programme and the national co-ordinating team is committed to
improving the existing quality systems and introducing even more
effective ones.''
Deaths in Scotland from cervical cancer have fallen from 244 in 1973
to 170 20 years later, a drop from 9 to 6 in the rate per 100,000
population.
The rate among 35 to 44 year-olds has actually risen, from 5:100,000
to 9:100,000.
* A 32-year-old nurse who had to travel more than 150 miles for breast
reconstruction surgery yesterday urged women to speak out and ask for
the treatment.
Ms Claire Brown, from Glenurquhart, near Inverness, had to ask for a
referral to the specialist unit at the Western General Hospital in
Edinburgh for a joint operation to remove and rebuild her breast after
cancer was diagnosed.
The mother-of-two, who is due to be released from hospital today, is
backing the Scottish Breast Cancer Campaign, which has long argued for
equality of access for breast cancer sufferers to specialist units.
The results of rebuilding surgery are deemed to be much better if
carried out at the time of breast removal.
Raigmore NHS Trust, where Ms Brown was treated initially, has denied
any opposition to patients being referred to specialist breast units for
reconstruction surgery.
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