Breast screening is no longer a no-brainer

It may seem like a no-brainer to turn up at the breast-screening clinic when the summons falls through the letterbox. Most of us are scared of cancer. Most of us have heard that if you catch it early, there is more chance of a cure.

But for some years now, there has been a growing volume of dissent to this orthodoxy – and it hasn't come from anti-medical campaigners, suspicious of toxic drugs. It has come from within the scientific community. Those who are asking the big question – is breast screening always a good thing? – are from a group with one of the best-respected scientific pedigrees. This is the Cochrane Collaboration, set up to weigh the totality of scientific evidence and tell us what really works and what does not.

They have been publishing their findings in top medical journals, such as the Lancet and the British Medical Journal, and news organisations have run stories – but every time we have asked the NHS screening programme for a comment, the Cochrane findings have been summarily dismissed. Most scientists, we have been told, do not agree with the Cochrane researchers. Studies are cited that show screening saves lives.

I have felt for some time that there has been an element in all this of "don't frighten the horses" and, personally, I think it underestimates – nay, insults – the intelligence of women. Screening is not like vaccination. We are not going to infect anybody else if we don't go for breast screening. If a cancer is missed, it is an individual who suffers, not the population as a whole. But the information we are given in NHS screening leaflets, echoing the official rebuttal of the Cochrane studies, barely mentions any possible downsides to going along.

And, yes, there are downsides. Nobody disputes now that there is some "over-diagnosis" and "over-treatment". What the X-rays show is often not much more than a tiny spot on a screen. Once upon a time, cancer doctors believed every one of those would, if left, turn into an aggressive cancer with the potential to kill. A couple of decades ago, the approach to breast cancer treatment was root and branch – a "Halsted" mastectomy, named after the surgeon who excised as much of the chest as he could in the belief that he was saving lives. That doesn't happen any more – now surgery is conservative and as limited as possible. Doctors try to deliver the smallest, most effective, amount of surgery, drugs and radiotherapy because of the long-term damage they can cause.

But just as surgeons have backtracked on radical mastectomy, so now it may be time to backtrack on radical diagnosis. According to the Nordic Cochrane collaboration, not every spot on the X-ray will turn into aggressive cancer. Their statistical evidence – looking at the numbers of women screened in a big Swedish trial in the 1980s compared with those who were not – is that less cancers were found in those not screened. That is because, they believe, some early-stage cancers regress – they disappear again without causing any harm. Others, we know, grow so slowly that women will die at a ripe old age of something else.

Breast cancer treatment these days is very much better than when screening began. Survival rates are high. Urgent treatment of an invisible clump of mutant cells may not be necessary. Screening will always be important and should be available for those who want it – especially for women whose family history or other factors put them at high risk. But women should be told of the potential harms as well as benefits so they can make an informed choice – and where the X-ray picks something up, perhaps she can sometimes be given a waiting and watching option, as in men's prostate cancer.

But whatever the outcome of the review announced by the government's cancer director, Professor Sir Mike Richards, the most important thing is that it will have happened. Serious issues will be seriously discussed and women, many of them for the first time, will know that breast screening is not, in fact, just a no-brainer and that there are choices that can be made. Hopefully that will not be frightening, but empowering. Thank you, Sir Mike, for that.

Turkey earthquake death toll rising

Turkey earthquake death toll risingAn earthquake in south-eastern Turkey has killed more than 200 people, with hundreds more casualties feared. Rescue teams worked through Sunday night trying to free survivors crying out for help from under rubble.

The Turkish interior minister, Idris Naim Sahin, said the 7.2 magnitude quake on Sunday killed 100 in the city of Van and 117 in the badly hit town of Ercis, 60 miles (100km) further north. The death toll was expected to rise.

Overseeing emergency operations in Ercis, Sahin said a total of 1,090 people were known to have been injured and hundreds were missing.

Rescue efforts struggled to get into full swing following the quake, with electricity cut off as darkness fell on the towns and villages on the barren Anatolian steppe near the border with Iran.

Survivors and emergency service workers searched frantically through broken concrete using hands, shovels and torches or working under floodlights powered by mobile generators.

As dawn broke the scale of devastation became clearer. At one crumpled four-storey building in Ercis a team of firemen from the largest south-eastern city of Diyarbakir were trying to reach four children believed trapped deep in an apartment block as concerned bystanders looked on.

Nearby, aid teams handed out parcels of bread and food, while people wrapped in blankets huddled around open fires after spending a cold night on the streets.

The prime minister, Recep Tayyip Erdogan, said there were an unknown number of people unaccounted for under the collapsed buildings of the stricken towns and he feared the worst for villagers living in outlying rural areas who had still to be reached.

"Because the buildings are made of adobe [mudbrick] they are more vulnerable to quakes. I must say that almost all buildings in such villages are destroyed," Erdogan told a televised news conference in Van.

"We don't know how many people are in the ruins of collapsed buildings, it would be wrong to give a number."

There have been more than 100 aftershocks since the main quake, which lasted around 25 seconds at 1.40pm local time on Sunday.

In Van, a bustling and ancient city on a lake ringed by snow-capped mountains and with a population of 1 million, cranes shifted rubble off a collapsed six-storey apartment block where bystanders said 70 people were trapped.

There was much more damage in Ercis with 55 buildings flattened, including a student dormitory, in a town of 100,000.

The Red Crescent said a team of about 100 expert personnel had arrived at the earthquake zone to co-ordinate operations. Four thousand tents and 11,000 blankets, stoves and food were being distributed.

A tent city was being set up at the Ercis sports stadium. Access to the region was made more difficult as the earthquake caused the partial collapse of the main road between Van and Ercis, broadcaster CNN Turk reported.

The military issued a statement saying two battalions had been sent to assist the relief operations.

The Dogan news agency reported that 24 people were pulled from the rubble alive in the two hours after midnight.

One nurse told CNN Turk news channel the town's hospital was so badly damaged that staff were treating injured in the garden and bodies were being left outside the building.

Still on track? Lindsay Lohan could avoid jail 'as she gets backing from probation service'

It looked like Lindsay Lohan was in deep trouble after she was kicked off her community service program for habitually failing to turn up.
But according to celebrity website TMZ's sources, the Probation Department is not going to recommend she is sent back to jail at her latest court hearing tomorrow.
It is expected officials will tell the judge in a written report the Mean Girls actress is in 'substantial compliance' with the terms of her probation.
Judge Stephanie Sautner made it clear if the troubled star violated any court order she would go to jail, but the department's recommendation will doubtlessly carry great weight.
Though officials concede she was kicked out of the Downtown Women's Center for regularly not attending community service sessions, they will also note she has a year to complete her 360 hours, and still has enough time to meet her obligations.
The source also claims the department has been in touch with Lindsay's psychologist, who says she has gone 'regularly.'
And though she has not fulfilled Judge Sautner's directive to attend therapy once a week,  the psychologist is reportedly satisfied with her progress.
The report will note that Lindsay has completed her shoplifting course.
However there could be bad news for the star, as it is expected the Los Angeles City Attorney will be seeking a prison sentence.
They are expected to  argue the conduct that got her booted out of the women's centre is a clear violation of her terms.
Her hearing is set to go ahead at 10am tomorrow, where the judge will make her final decision about whether her violations are serious enough to warrant a return to prison.

Meanwhile her father Michael said he hopes his daughter is not forced to return to prison.
He said: 'I still contend that she doesn't belong in jail. She needs to get off all of the medication she's on, including the Adderall which is killing her.
'The one person that holds the key to Lindsay turning her life around is her mother Dina.'
But he does believe the Herbie Fully Loaded star needs to spend the foreseeable future in rehab.
He said: 'I want Lindsay to go into rehab for a year. She needs long term care.

'Between pictures of her with bad people and her teeth, it is quite evident that her problems have not been addressed or conquered.'
Michael also revealed his anger after seeing photos of Lindsay with hotel owner Vikram Chatwal in a hotel room hunched over a table seemingly with a rolled up note in her hand.
He said: 'He is a dirtball. Any father who saw his daughter in that position would be furious.
'Anyone can tell by the pictures that she was not in the right frame of mind.
'This guy has a horrible reputation, and I don't care how much money as he has, he has no class whatsoever.
'Other people may be around her for the wrong reasons but I'll only be around her for the right reasons.
'I refuse to be around her when she's in this state.'
It has also emerged the star has donated $50,000 to children's charity The Baby and I Foundation.
A source told RadarOnline: '“Lindsay was really keen to make a donation to the charity.
'Her main motivating factor was that she hoped to make children’s lives easier by way of their own mothers, as her own mom has done for her.
'It’s kind of convenient timing. Just as she gets all this negative publicity and is getting ready to head back to court, she’s shown to have a good heart and a caring nature.
'I’m sure it can only help her case when she has to plead before the judge.'

Hillsborough: truth in sight for families as PM vows to release secret papers on tragedy

IT’S taken 22 years of -dignified campaigning against a backdrop of vile slurs and distorted facts.

But relatives of the 96 Liverpool fans killed at Hillsborough have taken a step closer to learning the full truth as David Cameron pledged to release secret Cabinet papers on the 1989 tragedy.

The move comes after an online petition signed by 140,000 people forced a Commons debate today about the disaster and the disgraceful bid to shift the blame from the police to supporters.

MPs are also expected to agree in a vote that there must be no more cover-ups.

News the PM will publish the Government papers was welcomed by victims’ -families.

Chair of the Hillsborough Justice Campaign Margaret -Aspinall, who will be at today’s debate, said: “It’s important that we get these Cabinet minutes. You can’t have the whole truth of Hillsborough without them and we’ve been shouting to have them released for 22 years. We hope all documents will be released with no -censorship.”
Mr Cameron revealed his pledge in a letter to Labour’s Andy Burnham, seen by the Mirror.

He wrote: “The -Government is committed to full -disclosure of the -Hillsborough information it holds. We have proposed that disclosure takes place to the families prior to wider -publication.”

And Hillsborough campaigner Mr Burnham said: “The PM’s commitment to full disclosure of documents will be much -appreciated by the -families.”

Relatives will get to see notes of Margaret -Thatcher’s Cabinet talks on the tragedy at Sheffield during -Liverpool’s FA Cup semi-final clash with Nottingham Forest.

They have long suspected Downing Street set the tone for poisonous smears that blamed drunken fans for the crush while freeing police of any culpability.

The papers will be published after the families and the tragedy review panel have seen them.

An inquiry by Lord Justice Taylor pinned responsibility for the crush on police failings and poor stadium organisation.

Joanna Yeates jury see tinsel and toys on visit to flat

Strings of tinsel were still draped around the living room and a box of crackers lay unopened on a shelf.

On a bookcase there was a Christmas card that had been addressed but never sent, and a roll of wrapping paper lay unused beneath a table.

Jurors spent 22 minutes on Wednesday visiting the Bristol flat where the landscape architect Joanna Yeates was allegedly murdered by her neighbour Vincent Tabak eight days before Christmas last year.

They were told that her boyfriend, Greg Reardon, with whom she had shared the flat, had been back to their home to clear his belongings. But Yeates's things – her shoes, her clothes, her cuddly toys – remained as she had left them.

The jury had already heard the prosecution's version of how Yeates, 25, was allegedly murdered at Flat 1, 44 Canynge Road, Clifton. It is alleged that Tabak, 33, strangled Yeates on the night of 17 December before going shopping, possibly with her body in the boot of his car, and then dumping it on a roadside verge three miles from the flat.

On Wednesday morning, jurors left Bristol crown court to be shown key sites in the case. They was driven in a coach up Park Street in Bristol, where Yeates had enjoyed pre-Christmas drinks at the Ram pub with work colleagues before she was killed.

Accompanied by court officials and guarded by police officers, they left the coach when they reached upmarket Clifton and walked to Tesco Express, where Yeates bought a pizza on her way home, and to a second store where she bought two bottles of cider.

They briefly went inside Tabak's former home, Flat 2, but spent longer in Yeates's flat.

The Christmas decorations were poignant and so too were Yeates's personal possessions: her running shoes, boots and cycle helmet in the hall; a water glass, medicine and white comb on a bedside table.

Still in situ were hair straighteners, perfumes, body lotion and nail vanish. A purple jewellery box contained trinkets, earrings and hairgrips.

Also still there were two cuddly mice, a large toy spider, a My Little Pony figure and a ceramic smiley cat.

In the living room was a signed picture from members of the cast of the sci-fi comedy series Red Dwarf addressed to "Jo and Greg". There was a bowl of Love Heart sweets, and on a table an empty bottle of cider.

There were reminders, also, that this was a crime scene. All of the carpets had been removed and fingerprint dust could be seen on cupboards and in the shower.

Tabak, who has admitted manslaughter but denies murder, did not accompany the jury.

Before the visit, William Clegg QC, Tabak's barrister, asked the jury to consider certain areas closely. Clegg said he wanted jurors to think about the time it would take to walk from a pub called the Hophouse to 44 Canynge Road.

The prosecution has said Yeates was captured on a CCTV camera outside the pub as she walked home on the night she died. Its case is that Yeates would have taken just a few minutes to walk home after passing that camera, and was attacked within a few minutes of arriving back at her flat.

Clegg also asked them to consider carefully the view from the kitchen window in her flat. Clegg said the defence would say it was through this window that Yeates and Tabak, a Dutch engineer, first saw each other on the night she died.

In addition, Tabak's barrister asked the jury to cross to the other side of the road to 53 Canynge Road, where a party had taken place on the night of Yeates's death. The jury has been told that a partygoer heard screams as she walked up the path of number 53.

Clegg said: "We would like you to go there and have in mind, having already been to No 44, whether in your judgment you think it possible that the scream that was made inside the flat of No 44 could possibly be heard if you are standing outside No 53.

"The defence are going to suggest that it was by no means certain that the scream that was heard was connected to this event at all because of the distance involved."

The jurors completed their trip by visiting the verge on Longwood Lane, Failand, three miles from Clifton, where Yeates's body was found under a mound of snow on Christmas morning.

The six men and six women returned to the crown court, where they are due to hear the first evidence from witnesses on Thursday.