Playing politics with cancer
Cancer specialist Michael Baum says Labour’s targets for a speedier diagnosis of breast and cervical cancer could do more harm than good.
‘I can only see harm coming out of this. I can’t believe that this is in women’s interests whatsoever. It’s another utterly absurd attempt to politicise clinical practice.’
Cancer specialist Michael Baum is unimpressed by Labour’s election pledge to speed up the diagnosis of breast and cervical cancer. Baum, professor emeritus of surgery at University College London, has studied breast cancer for the best part of 30 years, and set up one of the first UK screening centres. He thinks Labour’s latest targets could cause more harm than good.
As part of the bidding war for the attention of women voters, Labour has pledged that by 2008, all suspected breast cancer cases will be seen by a consultant within two weeks, and all women will receive cervical smear tests within seven days.
We’re given an image of a gallant government running to save women from needless anxiety. Public health minister Melanie Johnson said: ‘Today, we are saying to all women: “You will be treated as urgent cases – because when you find something wrong with your breast there is nothing more urgent in your life”.’
Yet Baum says that clinics currently treat women as fast as they can – and that targets without more resources will change nothing. ‘Almost all the specialist units in the country offer a one-stop shop. Women are seen, they have their X-ray or biopsy, and they get their results on the same day. If that is not provided, it is quite simply because we don’t have the resources. If the government is not adding to the resources, targets just put pressure on another service, which means that another service implodes.’
And while it sounds good to say that women won’t have to wait for their smear results, this could be of dubious value to their health. Indeed, the fact that tests pick up a broad range of abormalities, many of which have little health effect, could actually intensify women’s anxieties. Baum says that cervical screening ‘may have a detectable population effect, but for the individual woman it’s a very, very small chance of benefit – about one in several thousand. And there are a lot of downsides, such as the over-diagnosis of borderline pathologies. This means that women think they have got cancer, but we are not sure what they’ve got. You get a lot of emotional cripples’.
Most of the improvement in mortality has come through better treatment for cancer, rather than speed of diagnosis. ‘There is this idea that the answer to cancer is “catch it quick, catch it early”; and as long as politicians perpetuate that myth it will inhibit progress. That isn’t the answer to cancer. The answer to cancer is better treatment. In the course of better treatment over the past 20 years there has been a 30 per cent reduction in breast cancer mortality. The government would claim that is due to screening, but we know that it’s not due to screening because you see precisely the same reduction in mortality in the under-50s and the over-65s, who aren’t invited for screening. We need more support for development of better treatment.’
According to Baum, cancer treatment should be a clinical matter for doctors, not the subject of election grandstanding. ‘It’s nothing to do with politics, and all to do with clinical medicine. By all means give us the resources to do our job, but let us decide what our job is. This is pure playing politics. It is an emotive issue; it’s a common cancer, and everyone knows someone who has had breast cancer.’
Once political gestures drive clinical decisions, the result is likely to be a less efficient and less orderly service. Baum reflects on the effect of Labour’s last set of cancer targets, made during the 2001 General Election, which promised that nobody suspected of breast cancer would wait more than two weeks before being seen. ‘What happened following the last initiative was that women who had symptoms but were not expected to have cancer were forced to wait longer and longer, in acute anxiety. In order to get around this, some GPs started defining everyone as suspected of having cancer. And we also ended up with a paradox that some of people who waited longest actually did have cancer.’
But far from rectifying the results of the last set of targets, the latest set will make things worse. ‘This will mean an intolerable pressure on already stretched resources. Clinics will be bursting at their seams. People will be waiting longer and longer in clinics, there will be more and more complaints, and doctors will make rushed decisions.’
What mammography misses, by Michael Baum
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