In May it was reported that, owing to an IT error, from 2009 to 2018, approximately 450,000 women aged between 68 and 71 were not recalled for their final mammogram appointments in England. Jeremy Hunt, the health secretary has been quoted as saying that between 135 and 270 women “may have had their lives shortened as a result”.  The panic-quelling response came very quickly. The Guardian newspaper reported that Sir
Richard Peto, a professor of medical statistics at Oxford University, had written that there is still substantial uncertainty about the exact ages that mammographic screening should start and end. Additionally, a group of academics and GPs wrote a letter to The Times newspaper saying that the women should not be concerned unless they notice a lump or other symptoms and that the breast cancer screening programme mostly causes more unintended harm than good; many women and doctors avoid breast screening as it has no impact on all-cause death; and that the most dangerous and advanced cancers are not prevented by screening programmes. Breast cancer charities retorted that mammographic screening remains the best tool available for detecting breast cancer at an early and therefore more easily treatable stage and we must not forget that the programme does save lives. The UK’s NHS breast screening programme began in 1988 and national coverage was reached in the mid-1990s. However, over twenty years on, there seems to be an increasing body of data to suggest that the ‘accidental’ harm resulting from mammography because of over-detection and over-treatment of clinically unimportant lumps has been underestimated. The often-quoted figure is that for every woman whose life is extended, three receive unnecessary surgery, chemotherapy or radiotherapy. Hence our ‘best tool available’ seems to be a rather blunt tool. Biomarkers, surely, could provide the refinement needed to stratify patients according to therapy response. This will enable the delivery of individually tailored treatment plans and so will, crucially, prevent the unnecessary administration of chemotherapy and radiotherapy. Work on this is, of course, underway. The EU-funded RESPONSIFY study in Germany has already led to two parameters being included into German breast cancer guidelines for the treatment of HER2-positive breast cancer. Additionally, a gene-expression panel that predicts whether chemotherapy will be beneficial for preventing recurrence is already being used, with some success for the low and high scores. Further work is needed, but perhaps the day is in sight where women will no longer undergo unnecessary chemotherapy.