2 responses to “When Caring Is Misunderstood”

1. 

   kaitiscotland

   Apr 11, 2026 at 1:52 pm

   Doreen, there is indeed a reduction in breast cancer mortality in those who are screened. The problem is that total mortality between screened populations and non-screened populations is not improved at all or indeed worsens it a little. There a few reasons for this.

   People who decide to go for screening are generally more health aware, don’t smoke or drink as much, exercise more, are wealthier, and are thinner. This is called the healthy user effect. So these people tend to get cancers and heart attacks etc later than the poorer, fatter, smoking, drinking, less health aware group.

   The next issue is that more smaller cancers are discovered by screening. It is thought that it would take about a year for a lot of these lumps to become palpable clinically, so the lumps detected by screening are discovered earlier in their life span. This automatically gives the screened group a head start. They will get at least a years increase in life expectancy due to the earlier discovery and of course the cancer will be more readily treatable and be less likely to have spread.

   The next issue is the treatment effects. The problem with screening is that the clinician can’t tell which cancers would have just sat about not doing much, not spreading, and not causing symptoms or death in the future and those that won’t. Therefore they have to remove all of them. It doesn’t seem to be mastectomy or lumpectomy per se that it is the problem that affects total mortality but the effects of radiotherapy in particular but also the effects of chemotherapy.

   If you get radiotherapy you get an increased mortality from the effects on the lung (mainly chronic obstructive airways disease) and on the heart (mainly arteriosclerosis). The heart attack rate in women with breast cancer increases dramatically ten years and more after the breast cancer treatment. Many women who have breast cancer are also not able to get HRT which tends to reduce cardiovascular events, especially for oestrogen only HRT in women who have had a total hysterectomy.

   The chemotherapy is related to a small increase in blood cancers years after breast cancer treatment. The magnitude of this effect is much smaller than the lung and heart effects from radiotherapy.

   Of course the women whose cancer would have spread will have their lives saved, but the women, particularly older women who would have died of something else before the breast cancer would have revealed itself, or who have intraductal carcinomas tend to do a worse. There is a lot of current debate about how intraductal carcinomas should be treated right now.

   I specifically asked the Cochrane Collaborative for further information regarding this important topic after reading a BMJ paper about the problems of screening, and there is no benefit in total mortality rate from breast screening. Their exact words were ” the total mortality rates are more nuanced.”

   It sounds like your friend may have her head in the sand, but unless she has a very strong history of breast cancer in the family, she may not be wrong in avoiding mammography. It is not a risk free thing to embark on and I am very much in favour of the risks being spelled out in a frank manner. Unfortunately the publicity and “information” that they give women is heavily biased in favour of screening instead of being factual, balanced and neutral. The same emotional nonsense is behind efforts to bring in prostate cancer screening.

   Bowel cancer screening does at least give a total mortality benefit compared to non screened groups. The NNT site says that the difference in total mortality is an increase in 2 weeks in the screened group. If bowel cancer runs in her family then there is more of a reason to get this done. One tip is that if a colonoscopy is negative, then the chances of getting bowel cancer in the next ten years is very low. If polyps are found, then they can be removed before they potentially become cancerous. If cancer is found, it can be treated much more easily. Of course mishaps do occur if the bowel is perforated during the procedure. This results in an operation to mend the bowel and can have serious results. A woman developed renal failure, for instance, and she was unsuccessful in suing the surgeon, because it was a known complication. I’m pleased to say that the information about bowel cancer screening tends to be more balanced, factual and neutral compared to breast cancer screening.

   Your friend needs to make up her own mind. Show her this post if you like and research the information yourself. Remember that total mortality rate is the important statistic not just the ailment in question.

   This post does not constitute medical advice. All readers need to research this topic for themselves or discuss with their own trusted health care professionals.

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   1. 

      doreenshealthandwellness

      Apr 11, 2026 at 2:02 pm

      Thank you so much for the information. It was very powerful!🩷

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