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79 Medico-Legal J. 1 (2011)

handle is hein.journals/medlgjr79 and id is 1 raw text is: Medico-Legal Journal (2011) Vol. 79 Part 1, 1 2. DOI: 10.1258/mlj.2011.011006 ( Medico-Legal Society 2011 EDITORIAL Breast Cancer: Does Universal Screening Do More Harm Than Good? Discuss Diana Brahams Editor When I was a child and even a young and not-so-young adult, cancer was not a topic that many people were keen to discuss and few people vol- unteered that they or their relatives had been diagnosed with it. It was often kept secret even after death as if it was contagious like the plague. A good example of this lies in the d6nouement of Daphne Du Maurier's novel Rebecca. The prognosis for most cancers was grim as were the treatments (and they're not a walk in the park today, either). However, in more recent years there has been a huge shift to make this and other killer diseases (e.g. AIDS) acceptable for general conversation and debate. It is surgeons and researchers like Professor Michael Baum who have successfully wrought a positive shift in patients' and doctors' attitudes to dealing with cancer. In his book, Breast Beating (a personal odyssey in the quest for an understanding of breast cancer, the meaning of life and other easy questions)' Baum explains that it was his mother's death from (ineffectively and horribly treated) breast cancer which prompted him to shift his career to search for better, scientifically proven methods of diagnosis and treatment of the disease and to adopt rigorous standards of critical analysis (whether counter-intuitive or against his own practices or unproven therapies that sound good to the ear) for the rest of his life. As a result of the work of Professor Baum and many other dedicated colleagues, the mutilating, crippling and painful breast surgery that was once the norm has been proven excessive in all but a tiny minority of cases. Always a champion for a cause he believes to be fair and right, Professor Baum will provide expert advice where there is a possible legal claim for compensation. He is never afraid to say No. No, there is no negligence and/or no there is no case to be made on causation albeit there has been delay and practice falls short of ideal; it can be difficult to prove that the patient has lost a greater than 50% chance of a significantly better outcome. And what about the medico-legal case for univer- sal screening for breast cancer? Does earlier detection of abnormalities in the breast really increase life- expectancy and reduce morbidity in most patients? Baum does not think so though he was once a keen supporter of screening, and in 1987 after the Forrest Report was published, he was commissioned by the Department of Health to set up the first screening unit and training centre in London. However, he soon became sceptical and increasingly convinced that any benefits from universal screening were out- weighed by over-diagnosis, which resulted in unnecessary surgery and other treatments given to healthy women. In 1997 he resigned from the NHS Breast Screening Programme (BSP) in disgust at the way women were being coerced into screening. In February 2009 there was more evidence that general mammographic screening caused harm (and a rise in mastectomies) in a paper published in the British Medical Journal by the independent Nordic 2 Cochrane Centre. Contemporaneously, Baum and 27 other experts wrote to The Times (19 February 2009) explaining the problems and arguing that the dramatic decline in mortality from breast cancer is as equally likely to be due to better treatments as to earlier detection by screening. The letter continued ... there are harms associated with early detection of breast cancer by screening that are not widely acknowledged. For example, there is evidence to show that up to half of all cancers and their precursor

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