What the papers say! Exploring the myths of the media Miss Tena Walters MB BS, FRCS, MS Consultant Breast Surgeon BMI and The London Breast Clinic 108.

What the papers say! What the papers say! Exploring the myths of the Exploring the myths of the

mediamedia

Miss Tena Walters Miss Tena Walters MB BS, FRCS, MS MB BS, FRCS, MS

Consultant Breast SurgeonConsultant Breast SurgeonBMI and The London Breast ClinicBMI and The London Breast Clinic

108 Harley St108 Harley St

Metro 1Metro 1stst September 2011 September 2011Tariq TahirTariq Tahir

Breast Cancer Screening benefits Breast Cancer Screening benefits overstated overstated

Gotzsche and JorgensenGotzsche and Jorgensen

Women undergoing screening are Women undergoing screening are misinformed about drawbacks misinformed about drawbacks

Its effectiveness is overstatedIts effectiveness is overstatedSurvival rates are due to better treatment Survival rates are due to better treatment Over-diagnosis leads to unnecessary Over-diagnosis leads to unnecessary

mastectomymastectomyCalled for ‘honesty’ in the NHSCalled for ‘honesty’ in the NHS

Disadvantages of ScreeningDisadvantages of Screening

CostCostFalse positives: 2 dimensional picture of 3 False positives: 2 dimensional picture of 3

dimensional structuredimensional structureOccult and low grade diseaseOccult and low grade diseaseRadiation exposureRadiation exposure

Same as 4 days Same as 4 days 1/60 th CXR1/60 th CXR 1/250 th CT Scan1/250 th CT Scan 10 minutes on a transatlantic flight10 minutes on a transatlantic flight

Breast Cancer Benefits Overstated Breast Cancer Benefits Overstated Response from Response from

Prof Julietta PatnickProf Julietta Patnick1 life saved for every 400 screened1 life saved for every 400 screened97% women with screen detected 97% women with screen detected

cancers alive after 5 years compared cancers alive after 5 years compared with 80% of all women diagnosed without with 80% of all women diagnosed without screening screening

1400 women saved per year by NHSBSP1400 women saved per year by NHSBSPMortality in the screened population Mortality in the screened population

proven to be lowerproven to be lower

NHS BSPNHS BSP

Mortality from breast cancer decreased by Mortality from breast cancer decreased by 30% since introduction of screening 30% since introduction of screening

Lowest mortality since 1950’s Lowest mortality since 1950’s Mortality decline similar in 50 – 60 year old Mortality decline similar in 50 – 60 year old

group and 40 -49 year oldgroup and 40 -49 year oldSince introduction of screening Since introduction of screening

symptomatic service greatly streamlinedsymptomatic service greatly streamlined Increase in public awareness and Increase in public awareness and

decrease in stigma decrease in stigma

European trendsEuropean trends

Increase in mortalityIncrease in mortality RussiaRussia

Decrease in mortality Decrease in mortality UKUK GermanyGermany ScandinaviaScandinavia Poland Poland Czech RepublicCzech Republic AustriaAustria SwitzerlandSwitzerland

Pain killer heart alertPain killer heart alertThe Daily MailThe Daily Mail

2828thth September 2011 September 2011Tamara CohenTamara Cohen

DiclofenacDiclofenac

No need to panic! No need to panic! 17 million prescriptions17 million prescriptionsDr Patricia McGettigan Hull York Medical Dr Patricia McGettigan Hull York Medical

SchoolSchoolStudy of 3 million people showed risk of 40%Study of 3 million people showed risk of 40%Meta analysis of case control / cohort studiesMeta analysis of case control / cohort studiesDiclofenac summary relative risk of 1.4Diclofenac summary relative risk of 1.4Naproxen 0.97 Ibuprofen 1.07Naproxen 0.97 Ibuprofen 1.07

Comments -PainsupportComments -Painsupport

‘‘an even better health move would be to give up an even better health move would be to give up reading the Daily Mail altogether’reading the Daily Mail altogether’

‘‘Newspapers print to sell not to inform’Newspapers print to sell not to inform’

‘‘if you listen to breaking news – we’ll be broken if you listen to breaking news – we’ll be broken before them’before them’

‘‘dying of a heart attack more attractive than living dying of a heart attack more attractive than living in pain’ in pain’

Calcium Supplements Calcium Supplements

Calcium Supplements and Heart Calcium Supplements and Heart Disease Disease

Daily Mail 30Daily Mail 30thth July 2010 July 2010Calcium Supplements risk 30% higher risk of Calcium Supplements risk 30% higher risk of heart attacks heart attacks

Meta analysis of 11 trials - 2007Meta analysis of 11 trials - 20071000 people 14 more heart attacks 10 strokes and 1000 people 14 more heart attacks 10 strokes and

26 fewer fractures26 fewer fractures

Randomised study in USA in 38,000 patients Randomised study in USA in 38,000 patients showed reduction in cardiovascular events in showed reduction in cardiovascular events in 20082008

The Independent The Independent 55THTH October 2011 October 2011

Melanie Newman and Oliver WrightMelanie Newman and Oliver Wright

Alternatives available cheaperAlternatives available cheaper

Cipramil costs £1.31Cipramil costs £1.31Cipralex costs £14.91Cipralex costs £14.91Cost to the NHS of £3.3 millionCost to the NHS of £3.3 million

Only one trial showed significant difference Only one trial showed significant difference between the two drugs but trial was by a between the two drugs but trial was by a company called Arbacom which has not company called Arbacom which has not sponsored any research before or sincesponsored any research before or since

Anti hypertensive medicationAnti hypertensive medicationCalifornia teachers study cohort California teachers study cohort

Increase in breast cancer risk 1.18Increase in breast cancer risk 1.18

Er positive tumours rr 1.21Er positive tumours rr 1.21

Premenopausal 1.56Premenopausal 1.56

No link in post menopausal womenNo link in post menopausal women

What’s New?What’s New?Herceptin and antibody combinationHerceptin and antibody combination

Fewer side effects Fewer side effects

14 month disease free interval compared 14 month disease free interval compared with 9 month disease free intervalwith 9 month disease free interval

The Holy Grail of cancer medicine The Holy Grail of cancer medicine