The benefits and harms of breast cancer screening
An independent breast screening review was published on 30 October, 2012. Commissioned jointly by Cancer Research UK and the Department of Health (England) it sets out a review of evidence concluding that roughly one death from breast cancer is prevented for every three cases overdiagnosed and treated. It recommends that the breast screening programme should be continued but that information should be available to women to enable them to make informed decisions.
At PHG Foundation we have been interested in breast cancer screening for a number of years through our involvement in the COGS project, a European Commission funded (FP7) programme focused on genetic susceptibility and risk stratification for breast, ovarian and prostate cancers. Through modelling we have particularly looked at the possibility of tailoring breast cancer screening (for example, starting date or frequency of mammography) according to risk and the many practical, ethical, legal and social issues that would arise. Estimating risk using known susceptibility variants can be used to stratify the population in a way that has clinical utility for optimising prevention. Further, consideration of genetic components of risk has also led us to revisit the idea of prevention at a population level (such as proposed by the breast screening programme) and the emphasis on individual decision-making.