Professor James Haddow
Medical screening society founding member James Haddow died on 13 June 2020. An obituary can be found here.
The revised Editorial Board structure of the Journal of Medical Screening that was outlined in the April 2020 MSS Website News has been in operation for about half a year and is working well.
I encourage you to submit your PowerPoint presentations. Posting them on the Open Access MSS website is a membership facility at no cost to members. These postings disseminate member's research findings for the benefit of members and the public. The presentations can extend beyond screening. Advice on how to submit your presentations can be found here: https://www.medicalscreeningsociety.com/Presentations.asp.
We are considering a webpage on the MSS website to draw attention to publications of significant reports on screening. The focus would be on papers or chapters not published in the Journal of Medical Screening. A rather 'home grown' list of publications is given below. They may be of interest to members. Please let me know of others that would be of interest for inclusion in the MSS website.
Wald N, Law M. Medical Screening. In Oxford Textbook of Medicine (6th Ed). Firth J, Conlon C, Cox T (Eds). Oxford, Oxford University Press, 2020
ACOG Committee on Practice Bulletins − Obstetrics, Committee on Genetics, and Society for Maternal-Fetal Medicine Clinical Management Guidelines for Obstetrician-Gynaecologists. Screening for fetal chromosomal abnormalities. Obst Gyne 2020;136:1-22
Wald DS, Wald NJ. Integration of child-parent screening and cascade testing for familial hypercholesteraemia. J Med Screen 2019;26:71-75
Wald NJ, Old R. The illusion of polygenic disease risk prediction. Genet Med 2019;21:1705-7
Duffy SW, Smith RA. The evaluation of cancer screening Concepts and outcome measures. Med Clin N Am 2020;104:939-953
Sadly an Associate Editor, Dr James Haddow, passed away earlier this year. His Obituary is available here https://doi.org/10.1177/0969141320953244
Nominations for MSS membership are welcome. Please consider nominating colleagues or friends who would be interested. Nomination forms can be accessed here: https://www.medicalscreeningsociety.com/Subscriptions.asp
SAGE, the JMS publisher, wants new terms which are currently being discussed. I would like to move to free Open Access. This is a current option open to authors on payment of about $3000. Without this payment Open Access is only available from 2 years after the publication date. If you have any comments or suggestions I can be contacted by email: email@example.com.
Nicholas Wald 12 November 2020
In 2019 the Medical Screening Society office moved from the Wolfson Institute of Preventive Medicine to new premises at 29/30 Newbury Street, London EC1A 7HZ, UK. The telephone number is +44 (0)20 7600 1418, the fax number is +44 (0)20 7606 0506 and emails can be sent to firstname.lastname@example.org.
The Editorial Board of the Journal of Medical Screening, which is owned by the Society, has been revised. Professor Sir Nicholas Wald is the Editor-in-Chief and two new Editors have been appointed: Professor Stephen Duffy (Queen Mary University of London) and Professor Allan Hackshaw (University College London). A list of Editors and Editorial Board members can be found here [LINK]. Priscilla Goldby has taken over from Janette Mackie as Editorial Assistant. The Society is grateful to Janette Mackie for her valuable work on the Journal since its inception 26 years ago.
Nicholas Wald has left The Wolfson Institute of Preventive Medicine at Queen Mary University of London and has two UK academic appointments (University College London and St Georges University of London). He is also Adjunct Professor of Pathology & Laboratory Medicine at Brown University, Rhode Island.
The Society welcomes suggestions for topics and workshops. The Society encourages members and non-members to submit papers to the Journal of Medical Screening on any area of medical screening including, for example, screening for eye disease, cardiovascular disease, renal disease and prenatal screening; subjects that are under-represented at present in the Journal. Submission can be made here https://mc.manuscriptcentral.com/rsm-jms.
Members of the Medical Screening Society have the opportunity to submit their PowerPoint presentations for placing on the Medical Screening Society website which is Open Access. The presentations do not have to be limited to screening in general; they can, for example, cover epidemiology, statistics, public health and preventive medicine.
The current annual membership fee is £80 per year and includes online and physical copies of the quarterly Journal of Medical Screening. A membership application form can be found here https://www.medicalscreeningsociety.com/Subscriptions.asp.
Professor Jacob (Jack) Canick
Medical Screening Society founding member Jack Canick died on 19 May 2013. As a tribute to him and his teaching a new page provides downloads of many of his talks.
First comprehensive review of European breast cancer screening programmes finds benefits outweigh harm
A major review of breast cancer screening services in Europe, published in a special supplement of the Journal of Medical Screening, has concluded that the benefits of screening in terms of lives saved outweigh the harms caused by over-diagnosis.
The results show that for every 1,000 women screened every two years from the age of 50 to the age of about 68-69, between seven and nine lives would be saved, and four cases would be over-diagnosed.
The European Screening Network (EUROSCREEN) working group , with members from nine European countries where outcome of screening programmes have been assessed, reviewed the estimates of benefit in published European studies in terms of breast cancer deaths prevented, and the major harms, in particular, the rates of what are called “over-diagnosed” cancers. These are breast cancers diagnosed as a result of screening, which would never have given rise to any symptoms during a woman’s lifetime and would not have been diagnosed had she not been screened.
A second working group – European Network for Indicators on Cancer (EUNICE) – reviewed the organisation, participation rates and main performance parameters of 26 screening programmes in 18 countries, involving 12 million women, between 2001 and 2007 . The reports from both working groups have contributed to the review published today.
Stephen Duffy, Professor of Cancer Screening at the Wolfson Institute of Preventive Medicine at Barts and The London School of Medicine & Dentistry, part of Queen Mary, University of London (UK), who is one of the coordinators of the EUROSCREEN working group and co-author of the supplement, said: “This is the only comprehensive review of the results of breast screening services in Europe. It reports results from screening millions of women, and confirms that the screening services are delivering the benefits expected from the research studies conducted years ago. In particular, it is good news that lives saved by screening outweigh over-diagnosed cases by a factor of two to one.”
The researchers also found that for every 1,000 women screened, 170 women would have at least one recall followed by a non-invasive assessment before absence of cancer could be confirmed (a negative result), and 30 women would have at least one recall followed by invasive procedures, such as a biopsy, before confirming a negative result. Screening results that lead to recalls in these circumstances are called “false positives” and can cause women stress and anxiety until the negative result is confirmed.
Dr Eugenio Paci, Director of the Cancer Prevention and Research Institute in Florence, Italy, who is a second EUROSCREEN coordinator and co-author, said: “By weighing up the pros and cons of breast cancer screening programmes we hope to ensure that women are fully aware of the chief benefits and harms and can make a fully informed choice when they decide whether or not they wish to attend screening. There has been quite a lot of discussion recently over the worth of breast cancer screening and for this reason it is timely that the international group of experts has assessed the impact of population-based screening in Europe and has found that it is contributing to the reduction in deaths from the disease.
“We believe that not only should our conclusions be communicated to women offered breast screening in Europe, but that, in addition, communication methods should be improved in order to raise women’s awareness, and to make information more accessible, relevant and comprehensible.”
 “Summary of the evidence of breast cancer screening outcomes in Europe and first estimate of the benefit and harm balance sheet”, by the EUROSCREEN working group. Journal of Medical Screening 2012, volume 19, supplement 1.
 The EUROSCREEN working group included representatives of nine European countries: Denmark, Germany, Italy, France, Norway, Spain, Sweden, The Netherlands, United Kingdom.
 The EUNICE working group included representatives from 18 European countries: Belgium, Czech Republic, Denmark, Estonia, Finland, Germany, Hungary, Italy, Luxembourg, Norway, Poland, Portugal, Republic of Ireland, Spain, Sweden, Switzerland, The Netherlands, United Kingdom.
 Financial support was provided by the National Monitoring Italian Centre to host EUROSCREEN meetings and the supplement publication, and by the National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands to host a EUROSCREEN meeting.
 Breast cancer facts and figures:
- Worldwide, breast cancer is the most frequent cancer among women and approximately 1.38 million women were diagnosed with this disease in 2008 (the year for which most recent figures are available).
- In Europe, including non-European Union (EU) countries, 425,000 new cases of breast cancer were diagnosed in 2008 and 129,000 European women died of the disease.
Data source: Ferlay J et al. GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide. International Agency for Research on Cancer, 2010 (http://globocan.iarc.fr).
- In the UK breast cancer is the most common cancer among women, with more than 48,400 women diagnosed each year and around 11,550 women dying from the disease. The lifetime risk of being diagnosed with breast cancer is one in eight.
- The UK’s NHS breast screening programme detected almost 16,500 cases of breast cancer in 2009/2010.
Data source: Cancer Research UK key facts (http://info.cancerresearchuk.org).
- In Europe, approximately 100,000-140,000 cancers are detected by screening each year among women aged 50-69.
- The UK is conducting a review of breast cancer screening in order to assess benefits and harms, chaired by Professor Sir Michael Marmot, and to which Prof Duffy submitted evidence earlier this year.
Screening Code of Practice
On 22 May 2009 the Medical Screening Society, in conjunction with the Royal Society of Medicine, held a one day workshop entitled "Professional Responsibility in medical screening". The meeting was very successful.
Members of the workshop discussed the current problem of unevaluated and unregulated screening, including presentations on the requirements for worthwhile screening tests and programmes. Examples of both sound and unsound screening were given. The question of professionalism vs consumerism was discussed. We concluded that professional standards were needed, and proposals were made on what criteria needed to be adopted in assessing screening services offered. We plan to publish a summary of the conclusions.
The following contributors attended the meeting:
Dr Gary Bolger (PPP)
Mr Harry Burns (CMO, Scotland)
*Professor Jack Canick (Women and Infants Hospital, Rhode Island)
*Professor Stephen Duffy (CRC UK)
Dr Raanon Gillon (Imperial College London)
Dr Fergus Gleeson (Churchill Hospital, Oxford)
*Dr James Haddow (Inst. for Prev. Medicine & Medical Screening, Maine USA)
Professor Kay Tee Khaw (University of Cambridge)
*Professor Malcolm Law (Wolfson Institute of Preventive Medicine)
*Dr Peter Mace (BUPA Wellness)
*Dr Anne Mackie (National Screening Committee)
Dr David Misselbrook (RSM)
*Professor Joan Morris (Wolfson Institute of Preventive Medicine)
Rustam Salman (Hon Consultant in Neurology, Edinburgh)
Professor John Scholefield (Professor of Surgery, University of Nottingham)
*Dr David Wald (Wolfson Institute of Preventive Medicine)
*Sir Nicholas Wald (President, Medical Screening Society)
(Medical Screening Society members are marked with an asterisk*)
We thank all Medical Screening Society members who offered and gave their support to the workshop. Copies of the presentations made will shortly be available on the MSS website.
The dangers of over−zealous promotion of medical screening.
In the February 2007 issue of the Journal of Medical Screening Editorial titled "Screening: a step too far. A matter of concern" (14;4:163) the Editor, Nicholas Wald, criticised the over-zealous promotion of health screening services by insurance companies and other commercial concerns who offer tests of dubious benefit and possible harm. Professor Nicholas Wald argues that there needs to be a Medical Screening Code of Practice to protect the public.
Professor Wald questions the promotion, often by insurance companies (for example, Saga Insurance in their Saga MultiScan provided by Lifescan Ltd) for screening tests which have not been shown to have real benefit and which may even be harmful. "There is, emerging in Britain, a culture in which judgements on medical screening practice are being made in the absence of evidence….The culture needs to change, so that screening is subject to professional scientific assessment."
Specifically there have not been studies to show that either computerised tomography (CT) scanning of the heart, nor virtual (CT) colonoscopy, are of benefit, and the X-ray radiation exposure involved in both procedures is a concern, as described in a paper by Amy Berrington in the same issue of the Journal.
Bone density and cholesterol levels are important factors in the causation of osteoporotic fractures and ischaemic heart disease respectively. This may have led people to believe that they would also be good screening tests, but they are not; within a population they are poor discriminators of who will develop these disorders and who will not. Whether screening for diabetes is worthwhile is also still uncertain.
Anxiety over the risk of false positives and the false reassurance of false negatives is a concern with all medical screening. As is often said "In medical screening there is always some harm, which is only acceptable if there are also confirmed benefits that outweigh the harm."
If government regulation is to be avoided, health service providers, insurers and scientists need to work together to produce a Medical Screening Code of Practice. Such a code may help to reassure the public and better enable them to judge the value and benefit of screening services.