Physicians say there is no undue cause for alarm after it was revealed this week that up to 450,000 older women in England were not invited for their last breast cancer screening before their 71st birthday.
Jeremy Hunt, the secretary of state for health and social care, told the House of Commons that some women may have died because of a “serious failure” in the NHS programme.
However, some experts say that while this episode has underlined that computer algorithms may be flawed, it may not have caused serious harm to public health.
The routine breast screening programme invites more than 2.5 million women every year for a test, with women between the ages of 50 to 70 years receiving a screen every 3 years up to their 71st birthday. Around 2 million women take up the offer.
According to Public Health England (PHE), the screening programme detects around 18,400 cancers each year and saves 1300 lives.
Faulty IT Programme That Led to Missed Appointments
The problem came to light in January 2018 when an analysis by PHE found that a number of invitations for a final mammogram had not been sent to women between their 68th and 71st birthdays. This was because an IT error meant that a cut-off point of 70 was used, meaning that thousands of women each year were not being called for screening when they were aged 70.
On Wednesday, Hunt told the Commons “that there may be between 135 and 270 women who have had their lives shortened as a result”. He added: “I am advised that it is unlikely to be more than this range and may be considerably less. However, tragically, there are likely to be some people in this group who would have been alive today if the failure had not happened.”
The failure means that women who are affected will currently be aged up to 79.
A Catch-up Programme and an Inquiry
According to PHE, of the 450,000 women who were not invited for screening, 309,000 are still alive. Hunt pledged that these women would be given the opportunity for a new screening appointment.
All women younger than 72 who are affected and who are registered with a GP can expect to receive a letter before the end of May informing them of their appointment time and date. Women aged 72 years and older would be able to contact a dedicated helpline to discuss whether a mammogram would be beneficial for their particular situation. This is because for older women, there is a significant risk that screening will pick up nonthreatening cancers that could lead to unnecessary and harmful tests and treatment.
The IT failure has not affected Scotland, which uses a different system. Wales and Northern Ireland use similar systems to England but are not thought to be affected. However, work is underway to contact any women who have moved from England to other parts of the United Kingdom during the period concerned.
In his statement, Hunt also announced an independent review of the NHS breast screening programme to examine the clinical impact, IT systems, and any improvements that could be made to minimise the risk for a repeat incident.
The review will be chaired by Lynda Thomas, chief executive of Macmillan Cancer Support, and Professor Martin Gore, consultant medical oncologist and professor of cancer medicine at The Royal Marsden. It is expected to report its conclusions in 6 months.
Baroness Delyth Morgan, chief executive of the charity Breast Cancer Now, said it was “beyond belief that this major mistake has been sustained for almost a decade and we need to know why this has been allowed to happen.”
Breast Cancer Care said that by Thursday it had received almost four times the normal number of calls to its helpline since the failure was revealed.
Uncertainty About the Benefits of Screening Older Women
A number of experts have commented on the benefits and limitations of the breast screening programme. Sir Richard Peto, professor of medical statistics and epidemiology at the University Oxford, said that standard procedure in most GP practices in England was to offer X-ray screening to all registered women who were aged 50 to 70 years by December 31. “This approximately 3-year cycle has meant that the last routine breast screening invitation would usually be received at age 68, 69 or 70,” he said.
Sir Richard is also codirector of the Clinical Trial Service Unit at the University of Oxford, which is conducting the AgeX trial into whether there are benefits to extending the age range for screening, including to women after age 70. He told the Science Media Centre this week: “There is still uncertainty about the benefits and harms of additional screening after the age of 70, and although the randomised AgeX trial is currently addressing this, it is not expected to yield medically reliable results until about the mid-2020s.”
Paul Pharoah, professor of cancer epidemiology at the University of Cambridge, said: “I believe that the furore over the NHS breast screening programme error has resulted in unnecessary worry for those women who may not have received a breast screening invitation.”
Speaking to the Science Media Centre, he added: “Breast cancer screening has both harms and benefits and so, if some people have not been invited for screening they will have avoided the harms as well as missing out on any benefits.”
Pharoah explained that according to a 2012 report by the Independent UK Panel on Breast Cancer Screening, for every breast cancer death prevented there would be three cases where breast cancer would have been ‘overdiagnosed’. “Overdiagnosed cancers are cancers diagnosed by screening that would never have been diagnosed in a woman’s lifetime if she had not had screening,” he said. “Detecting these very small early tumours might actually do more harm than good.”
For more news, join us on Facebook and Twitter
Tidak ada komentar:
Posting Komentar