NCITA have recently hosted the first lecture in the NCITA educational lecture series ‘On the Shoulders of Giants’ on 27th April 2022. The lecture entitled “Screening for Cancer: The Good, The Bad and The Ugly” was presented by guest speaker Michael Baum, Professor Emeritus of Surgery and visiting Professor of Medical Humanities at University College London (UCL).
The lecture recording is now available on our YouTube channel to watch again or if you missed the live session.
Professor Baum gave a very thought-provoking talk starting with his motivation for entering breast cancer research, which was fuelled by seeing his mother suffering from breast cancer.
The start of a career in breast cancer research
“My mother Mary developed breast cancer in her mid-60s – she presented with metastases throughout the skeleton, .. the treatment failed to control her agony and led to her all her beautiful hair falling out. That made me very, very angry although I don’t know why I was angry on something as abstract as cancer, but in many ways, this kicked off my career… I decided I would devote my career to try and spare the suffering of my mother.”
Professor Baum went on to play an integral role in the setup of the British National Health Service Breast Screening Program (NHSBSP), following the publication of the Forrest report in 1986, a report that predicted screening could lead to a 25% relative risk reduction (RRR) in breast cancer mortality.
Catch it early, save the life and along the way save the breast?
“I was given the task of setting up the first of three pilot screening units in the country. So in 1988 myself, as Professor of Surgery, plus a Professor of Radiology and a Professor of Social Health, set up the first screening centre. The screening centre unit was set up in Camberwell and we called it Butterfly Walk – that was the name of the shopping centre. I was very proud it opened on time and on budget. I had a huge investment in this process I wanted it to work”
However, Professor Baum has subsequently been one of its key critics, in particular regarding the issue of overdiagnosis, which can lead to unnecessary overtreatment and impact quality of life.
After assessing the outcomes of breast cancer screening 8-10 years later, Prof. Baum observed a rise in the incidence of breast cancer, in particular duct carcinoma (DCIS), and an increase in mastectomy rates.
Several reviews also reported on the issue of overdiagnosis and overtreatment of breast cancer including Welch et al. (2016) who demonstrated that women were more likely to have breast cancer that was overdiagnosed than to have earlier detection of a tumour that was destined to become large and cause symptoms . Jørgensen et al. (2009) suggested that one in three breast cancers detected in a population offered organised screening is overdiagnosed and a Cochrane report (2013) found that screening did not reduce breast cancer mortality.
Future / next steps
Professor Baum’s ended his lecture with a quotation by philosopher Karl Popper: “It is not truisms that science unveils. Rather, it is part of the greatness and the beauty of science that we can learn, through our own critical investigations, that the world is utterly different from what we ever imagined”.
Whilst some of Professor Baum’s views are considered controversial by other experts within breast cancer screening, he gave a fascinating lecture, which challenges us to consider how current and established practices within cancer research, diagnosis and treatment can be further improved.
For further reading on recent developments in breast cancer research, such as risk-stratified breast screening, use of artificial intelligence (AI) and health economic evaluations, see reviews by Clift et al. 2021 and Freeman et al. 2021.
See our NCITA events calendar for details of future NCITA lectures as well as relevant external events in clinical cancer imaging research.