What are the harms and benefits of breast cancer screening?



As increasingly fewer women are going for breast cancer screening, one event at the Cambridge Science Festival - which starts on Monday and runs for two weeks - asks how can we make sense of the increasingly polarised debate about the harms and benefits of breast cancer screening?

The event (20 March), includes a multi-disciplinary panel of experts; Professor of radiology Fiona Gilbert from the University of Cambridge School of Clinical Medicine; Sir David Spiegelhalter, the Winton Professor of the Public Understanding of Risk in the Statistical Laboratory at the University of Cambridge; Dr Sian Taylor-Phillips from Warwick University Medical School; and Dr Stuart Hogarth, Lecturer in Sociology of Science and Technology at the University of Cambridge.

During the discussion, the panel explore how the breast cancer screening debate has developed since the 1970s, examine the challenges of interpreting the evidence base and communicating complex risk information, and describe how new technological options might address concerns about overdiagnosis. They consider the complexities of the debate from four different disciplinary perspectives.

Dr Taylor Phillips, an epidemiologist who works with the UK National Screening Committee, provides insights into the challenges of interpreting the evidence base. She discusses overdiagnosis, the original trials, disagreements in interpreting results, and how things have changed considerably since the 1970s when the trials were undertaken.

Professor Gilbert gives a clinical perspective and describes the new technological options in breast screening. She covers how the breast cancer screening debate has developed since the 1970s, the changes in the programme including age extension, double reading, ensuring high quality across the country with national standards, data collection, and national training programmes for radiologists and pathologists. Professor Gilbert also describes how new technological options might address concerns about overdiagnosis, for instance breast tomosynthesis, automated breast ultrasound or FAST MRI for women with dense breasts – a screening protocol for breast cancer that takes just three minutes.

Dr David Spiegelhalter discusses the challenges of communicating complex risk information to the public in screening programmes. He focuses on the potential benefits and harms of screening, highlighting the process that went into the development of the current 'pink' leaflets, and how the ideas they encapsulate can be taken into other domains, such as choosing additional therapies after breast cancer surgery.

Dr Hogarth provides a social scientist’s perspective on how the mammography debate has developed since the 1970s. He contextualises the mammography debate in the development of screening in the 20th century with an emphasis on the growing attention to evidence, evaluation and governance, and the recent rise of ‘screening scepticism’, as evidenced by the international Preventing Overdiagnosis conferences. He also contextualises what has happened in the UK in relation to other countries, for example the controversies in the USA and multiple European countries reviewing their mammography programmes.

A related event on 15 March, asks how far in advance can we detect cancer and how useful is early diagnosis? For the majority of cancer patients, a diagnosis is made after symptoms become clinically apparent. By that time, cancer is often at an advanced stage and treatments usually involve some combination of chemotherapy, radiotherapy and surgery. These treatments are gruelling and survival rates are highly variable depending on the type of cancer and the stage at which it is detected.

During the event, The sixth sense of the oncologist: how doctors can find cancer earlier and why you may not necessarily want to know, the panel of experts – Mr Vincent Gnanapragasam, University Lecturer in Uro-oncology and Consultant Urologist; Dr Maryon McDonald, Department of Social Anthropology and Editor-in-Chief, The Cambridge Journal of Anthropology; Dr Gianmarco Contino, clinical lecturer, University of Cambridge and Research Associate of the Von Hügel Institute; Dr Stephen John, Hatton Lecturer in the Philosophy of Public Health; and Dr Jacob Stegenga, Department of History and Philosophy of Science – discuss the incredible opportunities and hidden challenges of early cancer detection.

Other related events:

  • How lab discoveries are leading to earlier detection and more precise treatments for cancer patients (25 March) – scientists from the Cancer Research UK Cambridge Institute, MRC Cancer Unit and Hutchison/MRC Research Centre present a number of activities that show how cancer develops, grows, and spreads, and how researchers and clinicians are developing targeted, personalised therapies and techniques to detect cancer sooner.
  • Listening to light (25 March) – Michal Tomaszewski, Department of Physics, explores the various ways we can look inside the human body without touching it, and how different imaging technologies can be used to visualise different aspects of the organism and its function. He focuses on optoacoustic imaging which may help to differentiate benign tumours from aggressive cancer tumours.

To pre-book events, visit the Cambridge Science Festival website, or call: 01223 766 766.

Visit the Festival’s twitter site @camscience #csf2018, or Facebook page cambridgesciencefestival

Download the full programme here.

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