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| Worried sick | Worried sick |
| (about 2 hours later) | |
| By Brendan O'Neill | By Brendan O'Neill |
| Awareness of breast cancer is high due to numerous campaignsMedical experts and charities urge us to be more "aware" of cancer, but the trend for self-examination is causing anxiety and leading to needless operations. So can a little too much knowledge of the disease be a dangerous thing? | Awareness of breast cancer is high due to numerous campaignsMedical experts and charities urge us to be more "aware" of cancer, but the trend for self-examination is causing anxiety and leading to needless operations. So can a little too much knowledge of the disease be a dangerous thing? |
| It seems commonsensical that the more we know about the symptoms of various cancers, the more effectively we might spot warning signs in ourselves and visit a doctor for potentially life-saving treatment. | It seems commonsensical that the more we know about the symptoms of various cancers, the more effectively we might spot warning signs in ourselves and visit a doctor for potentially life-saving treatment. |
| Women of all ages are encouraged to examine their breasts regularly for lumps, bumps and other abnormalities and those over 50 are advised to have a yearly mammogram - an X-ray of the breasts that shows up abnormal growths. | Women of all ages are encouraged to examine their breasts regularly for lumps, bumps and other abnormalities and those over 50 are advised to have a yearly mammogram - an X-ray of the breasts that shows up abnormal growths. |
| Men, especially those aged 15 to 35, are encouraged to carry out monthly testicular self-examination (TSE), looking for symptoms of testicular cancer.It is the most common form of cancer in young men, with around 2,000 cases a year. | Men, especially those aged 15 to 35, are encouraged to carry out monthly testicular self-examination (TSE), looking for symptoms of testicular cancer.It is the most common form of cancer in young men, with around 2,000 cases a year. |
| Celebrity-backed advertising campaigns, posters in GPs' waiting rooms and even a range of T-shirts in Topman encourage young men to "check themselves" regularly. | Celebrity-backed advertising campaigns, posters in GPs' waiting rooms and even a range of T-shirts in Topman encourage young men to "check themselves" regularly. |
| Yet some medical researchers and cancer experts are now casting doubt on the benefits of these seemingly commonsensical tests. | Yet some medical researchers and cancer experts are now casting doubt on the benefits of these seemingly commonsensical tests. |
| Studies over the past few years have concluded that both self-examination and mass screening for signs of cancer can sometimes cause a good deal of harm - as well as good - generating widespread anxiety, giving rise to misdiagnosis and even leading to unnecessary and invasive surgical procedures. | Studies over the past few years have concluded that both self-examination and mass screening for signs of cancer can sometimes cause a good deal of harm - as well as good - generating widespread anxiety, giving rise to misdiagnosis and even leading to unnecessary and invasive surgical procedures. |
| Screening for breast cancer has been called into question, by someCould it be that too much awareness about cancer is potentially a bad thing? | Screening for breast cancer has been called into question, by someCould it be that too much awareness about cancer is potentially a bad thing? |
| "What seems like good and obvious advice in everyday life is not always scientifically or medically sound", says Peter Gotzsche, MD, director of the respected Nordic Cochrane Centre in Copenhagen. | "What seems like good and obvious advice in everyday life is not always scientifically or medically sound", says Peter Gotzsche, MD, director of the respected Nordic Cochrane Centre in Copenhagen. |
| Last week, Mr Gotzsche caused something of an international storm with his latest report on the benefits and harms of mammography screening. | Last week, Mr Gotzsche caused something of an international storm with his latest report on the benefits and harms of mammography screening. |
| His team of researchers examined international studies of more than half a million women, and found that for every 2,000 women screened for breast cancer over a decade, one will have her life prolonged but 10 will undergo unnecessary treatment. | His team of researchers examined international studies of more than half a million women, and found that for every 2,000 women screened for breast cancer over a decade, one will have her life prolonged but 10 will undergo unnecessary treatment. |
| "So we might say there is a benefit of one but a harm of 10 from screening for breast cancer", says Mr Gotzsche. | "So we might say there is a benefit of one but a harm of 10 from screening for breast cancer", says Mr Gotzsche. |
| Around a fifth of cancers picked up by screening are in the milk ducts of the breast, and sometimes these cancers do not progress to become life-threatening. | Around a fifth of cancers picked up by screening are in the milk ducts of the breast, and sometimes these cancers do not progress to become life-threatening. |
| BREAST CANCER AWARENESS Know what is normal for youLook and feel Know what changes to look for Report any changes without delay Attend for breast screening if aged 50 or over Source: NHS Cancer screening Programme/Cancer Research UK Breast screen 'wrong care' fears The Cochrane study found that, following screening, 10 in 2,000 women were having invasive and sometimes sickness-inducing procedures - including chemotherapy, radiotherapy or mastectomies - for cancers that may never have developed. The word "may" is, of course, crucial - women who underwent treatment might never know whether they will have escaped cancer or not. | |
| It also found that mass screening can lead to misdiagnosis. Two-hundred women out of every 2,000 experienced high levels of distress or anxiety as a result of "false positives" - results which suggest that cancer is present but which later turn out to be wrong. | It also found that mass screening can lead to misdiagnosis. Two-hundred women out of every 2,000 experienced high levels of distress or anxiety as a result of "false positives" - results which suggest that cancer is present but which later turn out to be wrong. |
| This study follows the Cochrane Centre's report into breast self-examination, published in 2003. | This study follows the Cochrane Centre's report into breast self-examination, published in 2003. |
| Based on 388,535 women from Russia and Shanghai, the earlier report compared the experiences of those who regularly self-examined with those who did not. | Based on 388,535 women from Russia and Shanghai, the earlier report compared the experiences of those who regularly self-examined with those who did not. |
| It found there was "no statistically significant difference in breast cancer mortality" between those who examined themselves and those who didn't- that is, there was little evidence that self-examiners lived longer in the event of finding breast cancer and having it treated. | It found there was "no statistically significant difference in breast cancer mortality" between those who examined themselves and those who didn't- that is, there was little evidence that self-examiners lived longer in the event of finding breast cancer and having it treated. |
| And it found that unnecessary interventions - biopsies which later turned out to be benign - were twice as common among the self-examining group. | And it found that unnecessary interventions - biopsies which later turned out to be benign - were twice as common among the self-examining group. |
| Men... self-examination... you get the pictureThis led some countries to register breast self-examination as "potentially harmful" and to discourage women from practising it. | Men... self-examination... you get the pictureThis led some countries to register breast self-examination as "potentially harmful" and to discourage women from practising it. |
| "We have to rethink the advice we give to the healthy population about cancer", says Mr Gotzsche. "Some of what we're doing at the moment seems to be quite harmful." | "We have to rethink the advice we give to the healthy population about cancer", says Mr Gotzsche. "Some of what we're doing at the moment seems to be quite harmful." |
| Michael Baum, emeritus professor of surgery at University College London and chair of the Psychosocial Oncology Committee at the National Cancer Research Institute, is concerned that the promotion of testicular self-examination(TSE) among young men may also bring harms alongside potential benefits. | Michael Baum, emeritus professor of surgery at University College London and chair of the Psychosocial Oncology Committee at the National Cancer Research Institute, is concerned that the promotion of testicular self-examination(TSE) among young men may also bring harms alongside potential benefits. |
| "There is no data to support the idea that detecting testicular cancer by self-examination improves on the mortality for testicular cancer", he says. | "There is no data to support the idea that detecting testicular cancer by self-examination improves on the mortality for testicular cancer", he says. |
| He's worried that TSE might give rise to anxiety, and even to unnecessary operations. | He's worried that TSE might give rise to anxiety, and even to unnecessary operations. |
| "Testicular cancer is a relatively rare cancer, whereas testicular lumps are quite common. | "Testicular cancer is a relatively rare cancer, whereas testicular lumps are quite common. |
| "So if we encourage young men to check their testes, their chances of finding a benign abnormality are considerably more than their chances of detecting cancer. | "So if we encourage young men to check their testes, their chances of finding a benign abnormality are considerably more than their chances of detecting cancer. |
| Celebrities like Gwyneth Paltrow have raised awareness of breast cancer"What we end up with are a lot of false alarms, with young men queuing up to see their doctors convinced they have cancer when in fact they don't. | Celebrities like Gwyneth Paltrow have raised awareness of breast cancer"What we end up with are a lot of false alarms, with young men queuing up to see their doctors convinced they have cancer when in fact they don't. |
| "The real downside to all this is that if testicular cancer IS suspected then the treatment is orchiectomy [the surgical removal of a testicle]. You don't biopsy a testicular cancer, you remove it. I can see a situation where men will have unnecessary orchiectomies." | "The real downside to all this is that if testicular cancer IS suspected then the treatment is orchiectomy [the surgical removal of a testicle]. You don't biopsy a testicular cancer, you remove it. I can see a situation where men will have unnecessary orchiectomies." |
| Some cancer charities and workers insist, however, that screening, and sometimes self-examination, continue to be useful. | Some cancer charities and workers insist, however, that screening, and sometimes self-examination, continue to be useful. |
| A spokesperson for the NHS Cancer Screening Programmes says the Cochrane Centre's figures on mammography do not apply to England. | A spokesperson for the NHS Cancer Screening Programmes says the Cochrane Centre's figures on mammography do not apply to England. |
| "Our programme helps a great number of women", she says. | "Our programme helps a great number of women", she says. |
| Where the Cochrane Centre found that as a result of screening over a decade one woman's life in 2,000 would be prolonged and 10 would have unnecessary interventions, the NHS Cancer Screening Programme says it has far better results. | Where the Cochrane Centre found that as a result of screening over a decade one woman's life in 2,000 would be prolonged and 10 would have unnecessary interventions, the NHS Cancer Screening Programme says it has far better results. |
| Hundreds of lives saved | Hundreds of lives saved |
| Earlier this year, the Advisory Committee on Breast Cancer Screening carried out a comprehensive evaluation of the NHS Breast Screening Programme in England. | Earlier this year, the Advisory Committee on Breast Cancer Screening carried out a comprehensive evaluation of the NHS Breast Screening Programme in England. |
| It found that for every 2,000 women invited to join the programme over a 10-year period, five will have their lives prolonged and only eight will have received treatment for cancers that may never have gone on to be life-threatening. | It found that for every 2,000 women invited to join the programme over a 10-year period, five will have their lives prolonged and only eight will have received treatment for cancers that may never have gone on to be life-threatening. |
| The evaluation also found that the NHS Breast Screening Programme saves 1,400 lives a year. | The evaluation also found that the NHS Breast Screening Programme saves 1,400 lives a year. |
| "Yes, the benefits and harms must always be weighed up", says the spokesperson. "But we believe our programme can be really beneficial to women." | "Yes, the benefits and harms must always be weighed up", says the spokesperson. "But we believe our programme can be really beneficial to women." |
| Everyman, the male cancer charity, argues that testicular self-examination can be useful. | Everyman, the male cancer charity, argues that testicular self-examination can be useful. |
| It advises young men that regular self examination "can help to detect this cancer at an early stage. | It advises young men that regular self examination "can help to detect this cancer at an early stage. |
| "If the cancer is not treated at an early stage, cancer cells can break away and spread to nearby lymph nodes or other organs." | "If the cancer is not treated at an early stage, cancer cells can break away and spread to nearby lymph nodes or other organs." |
Add your comments on this story, using the form below. | Add your comments on this story, using the form below. |
| I am 35 and this year was diagnosed with Malignant Melanoma. I hadn't been to the Doctors for 10 years. Fortunately this was in situ and as such I am fine. If however I had not at least been aware to look for changes it might have been diagnosed at a much more advanced stage. Fortunately for me my partner and my 2 young sons I did bother to check and then go to the doctors. I would recommend self examination to anyone. It quite literally could be the difference between life and death.David, York | |
| It is better to have surgery and not need it, than to need surgery and not have it.Chris, Kingston-upon-Thames, UK | |
| If my partner had not been so aware of his own body and found a testicular lump (very early on), he would not be here now. This was before the days of promotion of self-examination and annoyingly, the GP didn't even take it seriously. This ended up with a 6 week wait for Ultrasound during which time the tumour doubled in size, Thankfully, once the Urologist saw the results of the scan, he was admitted for immediate surgery. So, self-examination is a good thing and a well trained GP or hospital doctor will be able to tell the difference between a begign lump and a malignant tumour.Rich, London | |
| Can the same be said for smear testing? after all the introduction of 'foreign objects' and screening of such sensitive areas could cause damage / introduce bacterias?Kay, UK | |
| I would rather check myself and find something possibly benign, than not check and miss something potentially malignant.Annette, Lancaster, UK | |
| Having undergone surgery for a pre cancer breast cyst 8weeks ago,knowing in 4,5 or6years time I might have been looking at something much more serious. I thank God that I fell off my horse which kicked the whole matter off. Oh! including me.I have been cleared and thank all of the medical people involved for my care. Everyone,Keep examining.Wendy de Prieelle, Southport | |
| I went to the doctors last month as I found a lump, and the doctor told me that it cannot be cancer as I'm to young. As I said to him the reason that i'm here is that my nan died of breast cancer. I'm thinking of not going to doctors again if that is what I'm going to get told every time I go.Yvonne Newland, basingstoke Hampshire | |
| Sir/Madam. I found the above article interesting and informative. However, the concentration upon women and young men seemed to suggest that males over fifty are unlikely to get cancer. That this is patently untrue leads me to wonder why such a gender/age band was not given enough attention in this otherwise excellent article. G. Knott Graham Knott, Lincoln | |
| Often it is not so much a case of a little knowledge being dangerous as it is of patients thinking they understand health and illness far better than they do. I often have to spend huge amounts of time convincing patients that much of the "information" they have obtained from the TV and the net has been simplified to the point of being essentially incorrect.Christopher Jones, Aberdeen, UK | |
| I think it is vital that men and women check themselves for any lumps and bumps. I also think it is vital for women to have regular mamograms when they reach a certain age. My mum's friend regularly checked her breasts and everything appeared okay, but after a routine mamogram was diagnosed with breast cancer. The cancer was in it's early stages and if she hadn't had the mamogram it would have had to have grown a lot larger for a lump to be spotted. Because it was spotted early by the mamogram all the treatment she needed was the lump removed and a small course of radiotheraphy. She has now been clear for a year but if it wasn't caught as early as it was the prognosis would not have been so good. Scientists like working with statistics, but these statistics are people who have feelings lives, family and friends. Surely it makes sense for people to catch any cancer and other diseases they may have at the earliest stage to have the best chance of treatment and recovery?Marie, Northampton, UK | |
| As a sufferer myself,I am surprised that Prostate Cancer is not mentioned rather than testicular. It is the biggest killer of men in the uk (10,000 deaths a year and 32,000 diagnosed)and is treatable if found early. It is affecting more younger men (like myself in their40s). Therefore I would rather men were MORE aware rather than less. It is also shameful that it isn't given the same high profile as breast cancer.Alan Campbell, london | |
| I found a lump at Christmas, it was biopsied and found to be benign but I was encouraged to have it removed 'just in case'. It was removed in June. I'm 25, I have a scar on my breast and I catch viruses every three weeks due to my immune system being unbalanced by surgery. Not to mention all the stress before, during and after surgery. I understand that cancer would have been far worse but it WASN'T cancer. Cancer isn't even likely at my age. It was the worst decision I have ever made. Kelly, London, UK | |
| I have been "saved" by mamography, I feel very satisfied with the treatment I received.Ruth Helm, Walsall UK | |
| Not only is the constant barrage of informtation from all media too much, I think it raises the subconcious anxiety level in women of all ages and even effects our children; they, in turn, become anxious about what could happen to their parents. As for all the companies who sponsor "breast cancer awareness" products...they are shameless. In most cases just a "portion" of the sales price goes to research and the rest just pumps up their profits. It would seem all you have to do now is stick a pink ribbon on a product to raise CONSUMER awareness.Susan Beck, New York, USA | |
| If the Nordic Cochrane Centre says "as a result of screening over a decade one woman's life in 2,000 would be prolonged ...", but the NHS says "for every 2,000 women... over a 10-year period, five will have their lives prolonged...", does that mean that breast cancer is five times more common here than in the groups studied by the Cochrane Centre? It looks like the comparison in your article is meaningless because the groups being studied are entirely different.Richard Dearden, Birmingham | |
| I was diagnosed with testicular cancer aged 26, and it is only after an initial GP visit, an ultrasound, a second GP visit and consultation with a specialist that I underwent an orchiectomy. I'm staggered that Michael Baum can think that the promotion of self-examination could have a detrimental effect on the treatment of testicular cancers. I don't believe that any patient would undergo such a serious operation without the doctors being confident that it was the correct course of action to take. Young men are embarrassed enough about seeking medical help - as seen this week by the tragic case of a local 17 year old lad who was too embarrassed to seek advice - and the promotion of self-examination is only starting to make headway in breaking that pattern. Surely Professor Baum's comments will only set this progress back as young men worry unnecessarily that they will be operated on "willy-nilly" without a proper medical assessment.Martin Sharp, Stockton-on-Tees | |
| I was diagnosed with Testicular cancer in March this year, i self examined regularly and found the lump, it was removed very quickly, thou it still spread to my lymp nodes within the short time. Ended up having three months chemo, now got the all clear and living a full and normal life again. It is not all doom and gloom there is a lot of success storiesRG, Portsmouth | |
| But you are comparing different sorts of harm. The patients who might be having needless treatment (but noone knows which they are) are disrtessed unnecssarily but do not die. But without screening, some would die who would live longer if treated.julian, london | |
| Self examination caused my 32 year old fiancee to go for checks. A biopsy showed the lump was indeed cancer. Because it was caught at early stage it was removed before it could spread, and, after preventative chemo, she has a very good chance of it not returning. If she had not self examined it might not have been picked up until it was too late (young women are of course not given screening mammograms). Of course it MAY not have developed further, but I suspect a lot of women, having been told they have a breast cancer, would rather have it removed than know every day that it was there, and could potentially develop. Mr Gotzsche, for all his research, cannot give women the definitive prognosis they require to be able to decide to risk turning down surgery.Colin, London, UK | |
| Self-examination can help to catch cancer in its early stages, so definitely worthwhile. I've lost a friend and almost lost another to this disease. Anything we can do to protect ourselves and educate others can't be a bad thing.Lesley, Nottingham | |
| Digital mammograms are becoming increasingly available and are helpful for those with thicker tissue. They avoid having to repeat traditional scans with ultrasound follow-up.Candace, New Jersey, US | |
| This article is surely flawed by the phrasing of the question 'can a little too much knowledge of the disease be a dangerous thing?'. It assumes the answer by using the term 'too much'. Neil, Southampton | |
| With respect to Mr Baum what he's saying about TSE is complete nonsense and seems quite dangerous advice. If a lump is detected and ignored then if it is cancer it will spread and the possibility of recovery from a relatively treatable form of cancer falls greatly. Moreover the chance of the patient requiring chemotherapy and possibly radiotherapy rather than a simple and relatively painless operation increases. And while he is correct that the treatment is an orchiectomy I doubt such surgery would ever be unnecessary. Testicular cancer leaves distinctive markers in a patients blood so the whether or not cancer is present is known long before they send the testicle away to the lab. It is far better to be safe than sorry. Just over a year ago I detected a lump and made an appointment to see my GP. He was obviously from the same school of thought as Mr Baum as I was told that there was a lump present but that it was in all likelihood a cyst. Luckily my knowledge from the TSE campaigns meant I knew I was in a high risk group and so I didnt take my GP at his word and it was confirmed as cancer. Luckily because I'd caught it at an early stage despite the delay between me finding the lump and eventual diagnosis the surgery and 3 months of chemo seem to have done the trick. I hate to think what would have happened if I'd ignored it as Mr Baum seems to be suggesting.James, Exeter | |
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