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- W4079670 abstract "Editor—The recent wave of litigation in relation to screening for breast and cervical cancer is consistent with the current “compensation culture” but to some extent reflects a failure of both the public and its legal representatives to appreciate the principles and shortcomings of screening programmes.1There is an urgent need to educate women and give them accurate information so that informed decision making can occur and any adverse sequelae are better understood. Despite widespread publicity and vehement lobbying by patients' advocacy groups in the United States, surveys have revealed that women have little knowledge or understanding of the basic screening principles: over three quarters believed that the benefit of screening for breast cancer in women in the 40 to 49 year age group had been proved, and almost 40% thought screening was effective in women under 40 years of age, though no published data support such a benefit.2 Concepts of probability and numeracy may be difficult to convey during a clinical consultation even when the patient seems to understand the issues.3It is perhaps not surprising that the occurrence of interval cancers after a normal screening investigation evokes doubt and confusion, leading women to seek legal and financial recompense. The heterogeneity of breast tumours, with variable mean sojourn times and a range of biological aggressiveness, makes it difficult to estimate the prognostic significance of any delay in diagnosis. However, if a national screening programme is offered to women, certain levels of expectation must be honoured and the screening process rigorously monitored for quality assurance and outcome measures. Data from the NHS breast screening programme indicate that the screening interval is too long: more than 80% of cancers occurring within the screened population in the third year after a screening mammogram are interval cancers.4 Thus almost as many cancers develop between the second and third years as would be expected in an unscreened population. Moreover, interval cancers tend to be more advanced than those detected by screens. False negative rates of up to 40% have been reported in screening programmes, with retrospective review of mammograms showing a radiological lesion in 20% of interval cancers and a suspicious abnormality in a further 20% (S Ciatto, Advanced workshop in breast cancer management, Hong Kong, 1998).Two view mammography and double reading will help reduce false negative rates, but reducing the time between screens should also help to minimise true interval cancers. These changes will increase the staffing and financial costs of screening but will improve efficacy and in the longer term may avert potential claims of negligence." @default.
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- W4079670 date "2000-09-23" @default.
- W4079670 modified "2023-09-25" @default.
- W4079670 title "Screening and litigation. The rate of interval cancers is too high." @default.
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