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Thursday, February 4, 1999 Published at 00:58 GMT


Fury over call to privatise screening

Breast scans save thousands of lives

Screening for such conditions as strokes, heart attacks, cervical and breast cancer should not be available on the NHS, a leading doctor has argued.

Jim Thonton: "The private sector is more efficient and better value"
Screening advocates have dismissed the idea as "totally absurd" and warn it could places lives at risk.

Mr Jim Thornton, a consultant obstetrician and gynaecologist at Leeds General Infirmary, has written a report for the right wing think tank, the Institute of Economic Affairs.

In the report, Mr Thornton argues that for many people the costs of screening far outweigh the benefits.

Cervical cancer screening, for example, has enormous benefits for women whose condition is at the pre-cancerous stage at which abnormal cells can be identified and destroyed, Mr Thornton argues, but there are costs for all other women who participate.

"There are many false positives, and much pre-cancer regresses spontaneously," he says.

"Many women never destined to get cancer are made anxious, and some have unnecessary operations.

"Since the risk of cervical cancer increases with sexual promiscuity, abnormal smear results can provoke marital discord."

Mr Thornton said some women also regarded the screening programmes as not worthwhile, either because they particularly dislike vaginal examinations, or because they believe themselves to be at low risk.

Mr Thornton's intervention follows several high profile failures of the cervical smear programme, most notably at Kent and Canterbury hospital, where eight women died of cancer despite being given the all-clear following smear tests.

Three women who developed cancer despite tests at the hospital are attempting to sue the former health authority in charge of the programme for damages. They are awaiting a High Court judgment.

NHS abortions wrong

The NHS is wrong, says Mr Thornton, to screen for some conditions but not others. For example, pregnant women can be screened by the NHS for Down's syndrome and spina bifida in their babies, but not for deafness.

Mr Thornton attributes this to the fact that there are strong lobbies for the two former conditions whereas deaf people would be outraged by the implication that their condition made them inferior to hearing people.

He also argues that screening programmes could be the first step towards pre-natal screening that might one day extend to programmes to detect minor diseases, or even genes for supposed antisocial or disapproved behaviour.

Mr Thornton also argues that abortions should not be carried out on the NHS as some people are ideologically opposed to the practice and should not have to pay for it through general taxation.

Abortion in the case of disability also has the effect of making disabled people feel their lives are not valued, he says.

Thousands of women benefit

Screening should be carried out in the private sector, Mr Thornton argues, where it would be more responsive to consumer demand. People would be able to purchase the amount of screening they want.

[ image: The value of cervical smears has been called into question]
The value of cervical smears has been called into question
Julietta Patnick, coordinator of the NHS breast and cervical cancer screening programme, said four million women took a smear test, and more than one million women underwent breast screening every year.

She said the cervical smears programme was estimated to prevent 3,900 cases of cancer from occurring every year.

The breast cancer screening programme found 7,500 cancers early each year, she said.

"These women clearly feel the NHS is providing a worthwhile service," she said.

"We are not blind to the risks and limitations of screening, and we need healthy scepticism to challenge what we do in the NHS.

"Each woman has to weigh up the risks and benefits, but we believe the chances of benefit far outweigh the chances of harm."

Totally absurd

The chief executive of the Breakthrough breast cancer charity, Delygh Morgan, said: "Mr Thornton's suggestions are totally absurd - insulting to women and completely out of step with the public and Government thinking.

"In this country we have one of the best breast cancer screening services in the world.

"Why throw away the service we have spent 10 years building up which has saved so many lives and which gives so much reassurance to older women?"

She added: "Make no mistake, if charges were introduced the service would crumble as many women who could not afford to pay would simply not have the chance of screening."

Screening expert Professor Walter Holland, of the London School of Economics, said all NHS screening procedures were vigorously tested for their effectiveness before launch.

He said: "It is illogical to offer a test privately when the things you are testing for are common in the more deprived parts of the population and you are trying to reduce inequalities in health."

Dr Anne Szarewski, senior clinical research fellow at the Imperial Cancer Research Fund, said: "It only costs the NHS £34 a woman to screen for either of these cancers - if the screening service is privatised many people who may benefit from it will not be screened because they simply won't be able to afford it.

"Death rates from these cancers are falling but we fear that if the current service is not freely available to women these rates may rise again."

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