Yesterday morning Radio New Zealand covered a review of the national breast cancer screening programme. Reportedly it was commissioned because of resignations at the National Screening Unit which manages and supports screening.

I hope it goes much further. From client work we have been involved in this year, the Minister should be more concerned about whether the government is wasting a huge sum.  The cost/benefit balance of mass screening mammography is under question internationally.  See for example – here, here and here.

As reported by the Listener the Breast Screening Unit recently colluded with mammography providers to attack breast  thermography. The latter uses infrared heat signatures on skin to detect changes in breast health. The mammography campaign called thermography ‘dangerous’. On investigation it turned out that the danger was only that women might choose thermography when the breast screening promoters believe they should just rely on mammography.. 

In our opinion the attack may have been at least partly motivated by the screening programme supporters' extreme sensitivity to questioning of the value of their screening.  Some of those advising the Ministry and the NSU on the relative benefits of mammography and thermography appeared to have professional and/or financial interests in ensuring the mammography screening program continues.  The perception of thermography as a threat to the screening program, came at the same time as efforts were being made to downplay a scientific report questioning mammography’s cost/benefit justification.

Breast cancer is the a big preventable killer of New Zealand women.  Mammography may be the best early detection method for many women. But from what we saw of Ministry documentation there was little objectivity or rigour in the decision-making on screening matters. The NSU response to the international research casting doubt on the net value of mass screening was ludicrously defensive.

Worse from our clients' perspective, the Ministry would not discuss how publicity should best inform women of the pros and cons of the various procedures. Quite apart from their code obligations to be fair, in dealing with thermography providers they lacked simple courtesy. Apparently courtesy need not extend to those one disagrees with.

There is a real possibility that millions in precious health dollars are being wasted as a result of the poor performance of officials. If those responsible are among those who have left the Ministry, it is hard to be concerned. If  those remaining are those we've been tracking, there should be more to follow.

PS Lest there be misunderstanding, I do not purport to express a view on the merits of thermography or mammography despite having learned much more than I ever expected on them both. Their proper uses are for specialists to debate. It seems to me that thermography is likely to have value especially for women too young for mammography.  I would also encourage my family members to use free mammography screening. But that is a very different question from whether such mass screening is a sensible use of what it costs us as a country, and whether the money could save more lives used another way.