Liam Farrell - Rational breast screening debate is doomed

I read somewhere (so it must be true) that some oil tankers are so big that it takes 100 miles for them to turn around. The recent news about the fresh doubts on the efficacy of breast screening will probably encounter the same degree of fatal inertia.

The case can be briefly summarised; for every 2,000 women screened in a 10-year period, one life would be saved, 10 healthy women would have unnecessary treatment and at least 200 women would face psychological distress for many months because of false positive results.

At a time of scarce resources, and rationing without calling it rationing, the enormous expenditure involved in breast screening should surely be examined.

If those resources were diverted towards improving early detection and treatment, would outcomes be better?

The national cancer director for England, Professor Mike Richards, announced that he will lead a review. He said he was taking the 'current controversy very seriously'. Someone should tell him that a review already exists, one that involved 600,000 women and seven trials, published in The Cochrane Collaboration, no less. It concluded in January 2011 'it is thus not clear whether screening does more good than harm'. Which brings sitting on the fence to a new level; if it isn't clear after 600,000 women, it's never going to be clear.

However, the enormous expenditure is the very reason why any logical approach is doomed to failure and why there is zero possibility of any rational debate on the subject. Breast screening is a mind-bogglingly colossal, billion-dollar business, and a lot of people are making a lot of money on its back.

Consider the advanced technology involved, the expensive machines and the vast number of people employed in the business; are these people going to lie down without a fight and see their livelihood taken away from them?

That won't be the argument advanced, of course; we'll hear all the usual platitudes. It's not about cost, you can't put a price on life, every woman's life is precious. Which is absolutely true, of course, but some lives are obviously more precious than others.

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