Byline: PROFESSOR MICHAEL BAUM
FOR ME, one of the saddest events of 1998 was the death of Linda McCartney from breast cancer. Linda stands as the representative of the hundreds of women with the disease who attend my clinics each year, and the thousands who die from it nationwide.
She lived an enviably healthy lifestyle, her disease was caught early, and she received the best treatment, both orthodox and complementary, that money could buy. And yet she died.
Following her death, the call went out once again for women to be made more aware of this disease through health education, and for more and better breast screening, both of which would aid early diagnosis.
If only it was that easy.
The truth, I'm afraid, is that the public and political responses to the breast cancer epidemic so far have been largely pointless, and patronising to women everywhere.
On the one hand, we have breast cancer awareness campaigns full of alarming and essentially meaningless statistics. On the other hand, there are the false
reassurances that if women practice self-examination of their breasts - checking each month for lumps - and so catch it early, everything will be all right.
Then there is the NHS breast screening programme, which offers mammography - breast X-rays to every woman aged between 50 and 64 every three years.
I was one of the architects of the much-heralded programme set up in 1987 and there is no doubt that it has indirectly raised standards of breast cancer treatment nationally and is likely to have a modest impact on deaths from breast cancer.
BUT today I believe that breast screening may not be the best use of scarce NHS resources available to combat this disease.
The screening programme which costs [pounds sterling]35 milion annually is limiting funds for the introduction of new drug treatments, which is where real hope for conquering breast cancer lies.
Respecting women as I do, I feel a sense of indignation that they are being sold such simplistic solutions as those outlined above to the problem of breast cancer.
Let us, for once, face the facts.
For example, take the one in 12 statistic used by breast cancer awareness campaigns to describe the incidence of the disease. It is true; but unhelpful and unnecessarily alarming.
The one in 12 figure applies to the cumulative incidence over a lifetime of a woman who lives to be 85 - not one in 12 women regardless of their age group. Of the women who develop breast cancer, over half will live out their normal life expectancy - with the result that, ultimately, one in 26 women will die of the disease.
Twenty-five out of 26 women will die of other health hazards, such as heart disease and lung cancer.
The emphasis that doctors and health educators place on early detection is also problematic.
'Early' is a chronological word but it is used to mean small in the case of a breast tumour.
Yet the disease varies widely in the way it develops and the rate at which it progresses. At one extreme it can take just six weeks to grow from one cell to a lump of one centimetre; at the other, it may take six years to reach the same size.
The majority of breast cancers
are, in fact, slow growing, and by the time a woman can detect a lump it has been there several years and her chances of recovery are predetermined. The good tumours will be cured and the bad tumours not, regardless of how early or late they were detected. Of course this is an uncomfortable fact, but it is a fact.
It is also a fact that three large-scale studies have shown that intensive instruction for women showing them how to check their breasts for suspicious lumps does not lead to a fall in deaths from breast cancer.
What it does do is double the number of false alarms and unnecessary operations to remove breast tissue for examination. …