October 2017 April 2015 | Seite 16

Te Puawai
There is significant harm resulting from
overdiagnosis of breast and prostate cancers.
There is harmful overtreatment for breast,
lung, prostate and ovarian cancer.
So there is not only no survival benefits from
‘getting it all’ or ‘getting it early,’ but attempts
to do so result in significant overdiagnosis
and harmful overtreatment.”
Peter Gotzsche
Peter Gotzsche’s lecture was based on his
2012 ground-breaking book “Mammography
Screening” Truth, Lies and Controversy” which
takes an evidence-based, critical look at the
scientific disputes and the information
provided to women by governments and
cancer charities. It also explains why
mammography screening is unlikely to be
effective today. (2)
A copy of the Nordic Cochrane Centre’s
booklet on Mammography Screening is
available in a variety of languages including
English at:
http://www.cochrane.dk/
The
discussion
that
followed
the
presentations from both men revealed that
many of the women in the audience were
unaware of the risks of mammography
screening and were shocked and dismayed
at what they had just heard.
Alexandra Barratt

In the “How to do better” section of her
paper Professor Barratt referred to the need
for quality information for patients:
“Many women continue to be prescribed or
encouraged to undergo screening rather than
being supported to make an informed choice.
Women should be given information that has
been carefully developed and tested,
because information is an intervention that
may have both positive and detrimental
effects.
Screening targets for screening services
should be questioned, and consideration
should be given to ensuring the provision of
balanced information – for example, using
the “consider an offer” approach outlined by
Entwistle and colleagues in 2008. Practitioners
should not be incentivised to achieve
participation, nor should high participation in
screening be regarded as a marker of health
service quality.” (3)
In conclusion the AWHC hopes that
BreastScreen Aotearoa will rise to the
challenge in Professor Barratt’s paper and
revise their nine pamphlets, two booklets,
three posters and five information sheets to
present women with the balanced information
they need to make an informed choice about
screening.

References

On 3 March 2015 the British Medical
Journal published Alexandra Barratt’s paper
“Overdiagnosis in mammography screening:
a 45 year journey from shadowy idea to
acknowledged reality.” (3) Alexandra Barratt
is a professor of public health at the
University of Sydney and was one of the
speakers at the Preventing Overdiagnosis
conference held at Oxford University in
September 2015.
© Te Puawai

1. https://www.nsu.govt.nz/news/screeni ngmatters-issue-50-february-2015/bsa-healtheducation- resources-being-reviewed
2. Peter Gotzsche. “Mammography
Screening: Truth, Lies and Controversy.”
Radcliffe Publishing 2012.
3. http://www.bmj.com/content/350/bmj.
h867?etoc=

College of Nurses Aotearoa (NZ) Inc
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