Thousands of people have inundated a breast cancer screening helpline with calls as experts warned Jeremy Hunt had made women unnecessarily anxious by announcing that a computer failure had led to up to 270 avoidable deaths.
As the helpline set up by Public Health England dealt with more than 5,000 calls by midday on Thursday, the charity Breast Cancer Care said it had seen a surge in calls to its helpline, adding that those getting in touch were confused and angry.
With confusion growing over the scale of the problem, it emerged that one of England’s leading statisticians had advised PHE after the issue surfaced in January that there was no need to apologise or recall women for mammograms that may or may not have been of benefit to them.
A “key need” in any statements from PHE, wrote Sir Richard Peto, a professor of medical statistics at Oxford University, in an email seen by the Guardian, “is to convey effectively the substantial uncertainty that has existed, and still exists, as to the exact ages at which mammographic screening should start and end”.
It was reported in several media outlets that PHE had known about the issues as early as March last year. The Times, Daily Mail and BBC said two NHS trusts had alerted PHE to the fact that letters were not going out to some women, but were told it was a local matter rather than a national one.
The confusion at PHE, which oversees the screening programme, emerged after Hunt’s statement to the House of Commons, in which he apologised for a “major failure” that he blamed on a computer problem going back to 2009.
He said 450,000 patients had not received letters inviting them for a final mammogram between the ages of 68 and 71, and that up to 270 may have died of a breast cancer that could have been detected and treated early.
Letters are going out to 309,000 women who are said to have missed an invitation. Those aged 70 to 79 will be offered screening.
But Cancer Research UK and independent scientists questioned whether women would have died because of the missed invitations and pointed to the harms that can be caused by screening, as well as the benefits.
Paul Pharoah, a professor of cancer epidemiology at the University of Cambridge, said: “I believe that the furore over the NHS breast screening programme error has resulted in unnecessary worry for those women who may not have received a breast screening invitation.
“Breast cancer screening has both harms and benefits, and so, if some people have not been invited for screening, they will have avoided the harms as well as missing out on any benefits. There has been no mention of this at all in the coverage to date.”
An independent UK panel on breast screening said in 2012 that for every death prevented, three breast cancers will have been overdiagnosed. “Detecting these very small early tumours might actually do more harm than good. Some women with screen-diagnosed breast cancer will have unnecessary mastectomies, and some will have unnecessary radiotherapy,” Pharoah said.
Sara Hiom of Cancer Research UK said that although screening enables cancers to be caught and treated very early, they can be detected in other ways, such as by women going to see their GP if they feel a lump in their breast. “Women need to be reassured that the mortality risk from this failure is lower than is perhaps being discussed,” she said.
Peto said there is no good evidence yet for the benefits of breast screening over the age of 70. A trial called AgeX has begun, based at Oxford University, recruiting women aged 71 to 73, to test whether lives would be saved or not. But screening women in their late 60s has never been trialled.
Hunt said compensation would be paid to women or families where it could be shown that the screening failure had resulted in damage to their health or death. An independent inquiry chaired by Lynda Thomas, the chief executive of Macmillan Cancer Research, and Martin Gore, a professor of cancer medicine at the Royal Marsden NHS foundation trust, will investigate whether women have been harmed.
guardian.co.uk © Guardian News & Media Limited 2010