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	TX: 29.01.08 - Call You and Yours: Screening for Health PRESENTERS: PETER WHITE AND LIZ BARCLAY

	Downloaded from www.bbc.co.uk/radio4 THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE 麻豆约拍 CANNOT VOUCH FOR ITS COMPLETE ACCURACY. BARCLAY Hello and welcome today on Call You and Yours, we want to hear your views on the plans to extend medical screening programmes in the UK. We're already routinely screened for breast and cervical cancer and diabetes but the Prime Minister wants to introduce tests to identify people at risk of conditions like heart disease and to extend the types of screening available at GPs' surgeries. WHITE Do you think that approach would make us healthier or will money that could be spent on treating sick patients end up being used for screening the so-called worried well? Call us now on 08700 100 444, calls shouldn't cost more than 32 pence. Or you can e-mail us through the website at bbc.co.uk/radio4/youandyours or text the word YOU and your comments to 63399, that's unlikely to cost more than 15 pence. WHITE Now to today's Call You and Yours and we're talking today about screening. We want to hear your views on the plans to extend medical screening programmes. The Prime Minister wants the NHS of the future to prevent and detect diseases before they take a hold, with plans to introduce tests to identify risk factors for heart disease and to extend screening and GP - in GPs' surgeries. Do you think this approach could create a healthier nation or is there a danger that it will simply divert resources away from the sick toward the well? Dr Anne Mackie is director of the National Screening Committee and is with us; Dr Simon Griffin is a GP and a research programme leader for the Medical Research Council Epidemiology Unit and we'll be hearing from them in a moment. The number to ring with your views about this and your experiences of screening is 08700 100 444, that's 08700 100 444. Let's go to our first caller who is Douglas Walters calling from London. Douglas, good afternoon. WALTERS Good afternoon to you. WHITE So what's your - you've had direct experience of this? WALTERS Yes indeed and I think screening is the most essential thing that should be done. Several of my friends have died from prostate cancer and cancer of the colon and I thought as a precaution I'd get myself a body scan done on those two parts of the body. And in actual fact they had a special offer when I got the company doing it ... WHITE So you had this done privately? WALTERS Privately yes - for a whole body scan. So I had a whole body scan done which was very lucky indeed because it came back that I had a polyp in the colon, which turned out to be non cancerous, so I had it cut out, so that's okay. But attached to my lung was a nodule, a small nodule, which turned out to be cancerous. Because it was caught early I had cut out by keyhole surgery and no chemotherapy and three years later I'm still completely clear of cancer. WHITE And this under - presumably this is not something that you would normally have thought of - or sort of thought of going for on the NHS? WALTERS No. WHITE Or would have known whether it was possible or not? WALTERS Friends of mine actually said to me: Doug, why are you having it done, there was nothing wrong, you've wasted your money? And I said: Don't be so stupid, it's given me reassurance, I've seen people die round me suffering from it, so therefore I'd be over the moon to know there's nothing wrong with me. WHITE Douglas, thank you very much indeed. Millie Keen is calling us. Millie good afternoon. KEEN Hello, good afternoon. WHITE Yeah what was the point you wanted to make? KEEN Well I mean I do agree with the screening for cancer because obviously to catch that early is important. My concern is that the emphasis on screening can result in prescribing medicines which haven't necessarily been proved to prevent the condition, such as for heart disease. And I'd like to use one example which is statins because there's no real evidence that statins prevent any deaths used in primary purposes, in other words people who haven't had any heart disease and their cholesterol's slightly lowered. And it's now become a block buster drug, really on the back of very, very small evidence ... WHITE Can I ask you, why do you think that that is stimulated by screening, surely the whole point is that either this is an effective treatment or not, I'm not quite clear why you think that screening makes it more likely - more likely to be pushed as it were? KEEN Well because when you have adverts in the Radio Times showing healthy young middle aged people and implying they were going to live longer and saying you could pop along to the chemist and have this test and get this wonderful drug, what it didn't tell you was that the drug can cause muscles to disintegrate, can cause depression, you know there was a recent death of a man who the coroner and the coroner's jury said was caused by the drug ... WHITE You're saying that it creates a demand if you like, it creates a pressure? KEEN Absolutely, it's what's called a disease awareness campaign and the Royal College of GPs actually announced when the government were doing an inquiry into the influence of the pharmaceutical industry their concern about disease awareness campaigns and the effects on the public and the cost to the NHS. WHITE Millie Keen .. KEEN And not only is it not helping people but it's actually making people ill, it's called iatrogenic illness, when the medicines actually make people ill. WHITE We've got some medical expertise at present, so we may come back to some of those issues. But thanks for making that point. 08700 100 444 is the number to ring. BARCLAY Yes as Peter said Dr Anne Mackie is director of the National Screening Committee and she's here. Dr Mackie, two different sides of the coin there, what's your response to that? MACKIE Yes, it's a very interesting take on screening. I think the first issue to talk about is screening for conditions when you don't think there is anything there - this private whole body scanning. There's been a recent report, produced by CAMARI [phon.], which suggests that it is extremely important that we are clear about what we're screening for, that the screening tests are not going to pick up things which are incidental, which may well lead to - lead to people being treated and investigated for things which aren't going to give them trouble in the long run. Now the first gentleman ... BARCLAY Douglas said yes. MACKIE ... yes was clearly - was clearly lucky with the lung cancer nodule but the story about his colorectal polyp is the other side of this - the other side of this coin and people need to be clear when they go for these whole body scans that they may well pick up things which won't give them trouble in the long run and this point about being reassured by a normal scan is also - is not necessarily true, the scans only pick up what they're designed to pick up and there may be other things that they've missed. BARCLAY Jane has e-mailed to say it would be better to screen those whose families have a strong history of diseases, a blanket screening is surely a waste of time and money. MACKIE I certainly think we shouldn't be going for blanket screening. The National Screening Committee has a series of criteria, we're up to 32 now, where we have to be clear that the thing we're screening for is a big problem, that we understand that we can intervene in the disease early enough to make a difference to stop people becoming seriously ill. But also that the test is likely to sift you into people who are much more likely to have the illness and much less likely to have the illness and not just test in case there's something there. BARCLAY Well let me bring in Dr Simon Griffin. Dr Griffin, I have an e-mail here that says: I work in a busy GP's surgery and everyday we send out letters to patients requesting them to make appointments for the screening - regular screening of conditions such as asthma, hypertension, diabetes, cardiac care and epilepsy etc. We follow those up, we send three letters and a telephone call, it takes hours of our time plus a great deal of money to implement the system but why or why in this health informed age do so many adults require so much nannying to look after themselves, they know they need this screening, yet they still fail to make let alone keep appointments? Another screening scheme, I think not. Is that how you feel about it as a GP? GRIFFIN I think the point is well made that a lot of work goes on into screening. The whole principle of screening is that you test vast numbers of people to find a few who might have a risk factor of disease who you then treat. The aim being that the people that you treat derive some benefit and hopefully they derive more benefit than the large number of people you've been tested suffered harm. The issue about screening in general practice is, it does take a lot of organisation and the people who tend to turn up are often the ones at lowest risk. So the people at the highest risk of the diseases you mentioned like diabetes, heart disease and so on are the ones who are least likely to attend. BARCLAY So what types of screening then are cost effective? GRIFFIN Well the National Screening Committee, of whom you've heard from the spokesman, evaluates screening programmes for their cost effectiveness at the population level and the sorts of things that look they're cost effective are things like breast cancer screening and things like abdominal aortic aneurysm screening which is about to be implemented. BARCLAY Called triple A I think. GRIFFIN Triple A absolutely. The example - it's crucially important that we do get evidence that something is cost effective. So the first thing we need to make sure of is that overall benefit of the scheme is greater than the net harm. And then that that overall benefit is worth paying for, rather than using the money for something else that people might want, such as hip replacements or reducing waiting times and so on. And the example that you've heard this morning from Douglas really illustrates this. The radiation exposure of a CT scan is several hundred times that of a chest x-ray, so while he was very fortunate in having found something possibly early and then treating, if we did CT scans on the whole population there'd be a real danger that we might cause more disease through this radiation than we'd actually prevent through early treatment. So when one evaluates things like drugs in the NHS you have to have very strict criteria and you'll be aware of all the furore over NICE deciding whether people could or couldn't have different drugs. Well we need the same degree of evidence if we're going to have a policy like screening because it will actually cost the NHS far more money than single prescribing decisions about drugs for relatively rare conditions. BARCLAY Right, well we are going to be taking more calls, there's another e-mail just here on the screen. As a GP, I, like my colleagues, endeavour to give a good service to patients, when somebody attends the surgery I would usually check their blood pressure and discuss checking their cholesterol and sugar levels and their weight. Offering screening will invariably appeal to the worried well and makes it sound as if it doesn't go on at the moment. Those at real risk will not attend and are often caught opportunistically. A good diet, weight loss and exercise as a recommendation would help just as many people. So there we are. You're listening to Call You and Yours on 麻豆约拍 Radio 4 with Peter White and Liz Barclay and we're discussing the efficacy of screening programmes. WHITE And the number to call us on 08700 100 444, you can still e-mail us and you can text us. Let's go straight to another caller - Jill Holroyd is on the line, Jill good afternoon. HOLROYD Hello. WHITE Yeah, do make the point you wanted to. HOLROYD Yes, well I think Gordon Brown's screening programme is a shameful waste of public money because it's very much at the expense of those of us with unpreventable and undetectable conditions who are being denied access to drugs and to the services we need on cost grounds. And it's not going to make irresponsible people anymore responsible. WHITE On the other hand those irresponsible people, as you call them, they will still cost the NHS money if their problems aren't detected early won't they? HOLROYD Well could I explain about - well my own condition for example, I have a younger form of rheumatoid arthritis which mine actually started when I was 10 but there are actually oh half a million plus people with rheumatoid arthritis which commonly starts in younger people, people under 40, and Gordon Brown says he wants to get people off benefit and back to work but people with rheumatoid arthritis who do want to work are being denied access to wonderful drugs by logic which can control the condition so that they can get back to work and become back to fully functioning members of society. And I think that's what the government needs to do - is to invest in people with unpreventable conditions, invest to save, instead of wasting money on more fancy new ideas which are questioned even by experts like Professor Pollock, on your programme last week. WHITE I mean I clearly understand your frustration at not being able to get your own drugs, the drugs that you feel you need and would be effective, but are you saying that we should apply a moral base to treatment, in other words treat those people who have done everything they can to stay well? HOLROYD No not treatment but screening, I think you know your first caller was concerned about screening so he went and spent some money on it himself. You know that's fine and as your GP said there is screening being done in - when people visit surgeries - cholesterol, blood pressure etc. - so - but the programme he suggests isn't the right way to spend the money that's limited already. WHITE Thank you very much for your call. Keith Thoms is calling us next. Keith, good afternoon. THOMS Hello. WHITE Yeah what's your view about this? THOMS Well I was one of the lucky ones. I live in the London Borough of Harrow and I went to see my doctor one day concerning a slight pain that I had. He referred me to Northwick Park Hospital for an ultrasound and I thought no more about it but then I discovered that I had an abdominal aortic aneurysm. WHITE A triple A, that's we've talking about, yeah. THOMS And - they reacted quickly and the team there, led by Mr Renton, performed the operation. I'm now at home recovering, I was only in there for a week. But I had a chance to do a little bit of reading round this subject and I understand that something like 3,000 men each year die as a result of the rupture of these aneurysms and the only - by the time the ambulance arrives with a rupture something like those that make the ambulance only two survive anyway. And I feel that perhaps this sort of condition, which I understand that 12-15,000 men over the age of 65 walk around with undiagnosed I believe that possibly if it was caught earlier could ensure that the National Health Service spend less money rather than more money. I know it's a question of priorities and primary care trusts have got their priorities but I think this is an area where we really need a lot more debate and it's about the health of men as well. WHITE Keith, thanks very much. Can I just quickly put that to Simon Griffin. Do you make a distinction then between the kind of screening that Keith has described there and this almost moral issue that was being raised before by Jill? GRIFFIN Well I think the key distinction I'd make in the case of Keith is it's not - what he underwent wasn't screening, he had some symptoms, he went to his doctor and he was investigated as he would have been if he'd the symptoms for a different other range of conditions. That's different from screening where everybody like Keith would be invited in for testing to see if they have an abdominal aortic aneurysm without knowing it. And I think that's the key difference. At the moment - or traditionally - doctors have responded to patients' needs and referred and tested them as appropriate but in screening you're going out and you're calling well people in who feel perfectly fine, they're sitting at home and you invite them in for a test. Now that test will have consequences, for a few people it may mean that their condition is diagnosed early and it means that their lives may be saved. And the randomised trials that have been done of abdominal aortic aneurysm screening suggests that it is a cost effective thing for the NHS to do. But for every few people who are like that a number of other people, the vast majority, will have given up their time, will have undergone this test, might have been made a little anxious, may even have been falsely reassured because the test isn't perfect, or may have been told that they have got an aneurysm when it subsequently turns out that they haven't. So when we're thinking about calling in well people to test them we really do need a good level of evidence that they're going to get benefit as opposed to responding to people when they come and see us in a surgery with a symptom where we do the best we can for them given their presentation. BARCLAY Well on that very subject in a speech Gordon Brown announced that for men over 65 a simple ultrasound test to detect triple A will be put in place. Professor Roger Greenhouse is professor of surgery at Imperial College, London and Charing Cross Hospital. Professor Greenhouse, is this a good decision? GREENHOUSE I think it's an excellent decision and I quite agree with Dr Griffin just now that the patient, Keith, was certainly one of the lucky ones. And the Prime Minister is certainly on the right lines we believe in the profession because as has come out in the programme already aortic aneurysm is a lethal condition and more often than not does not cause symptoms and so can exist in patients unknown and can rupture. And the point that Keith made, as a patient, was quite right - that approximately 75% of patients whose aneurysms rupture die before they get to hospital. Of those that get to hospital half die before they get to the operating theatre. So it is a lethal condition, the third commonest cause of sudden death in autopsy statistics. BARCLAY So you're saying that there is scientific - scientific evidence to back up this decision? GREENHOUSE Undoubtedly there is and there have been a series of excellent trials performed in Britain in which I think honestly through funding from the Medical Research Council and Health Technology Assessment Programme and the Department of Health there's been excellent work for some years and in this Britain really does lead the world. And we have shown that there's a specific size above which an aneurysm becomes dangerous. BARCLAY You're saying Britain leads the world in this situation yet this screening hasn't been embraced here while it's been embraced in the USA. GREENHOUSE We've led the world in terms of finding out what to do and what is on option. But as you've rightly said the United States have jumped in, as they did with penicillin, and have taken it on. They have recognised the work we've done. I have been invited and I've spoken in the United States at least five times in the last six months and they're doing it straightaway and putting it right across the board. So of course I'm delighted that the Prime Minister has agreed that this should be given priority. BARCLAY And do we know yet what difference it's making in the USA? GREENHOUSE It's too early but the work that's been done here is the key. First of all, the randomised control trial based on excellent work from Chichester showed that screening is effective and effective around GPs' surgeries, Alan Scott led that. But there's also splendid work in Cambridge and particularly in Gloucester. And in Gloucester they showed over a 20 year period that a population could be screened and the risk of ruptured aneurysm effectively eradicated over 20 years by doing timely surgery. And again your comments are right - Dr Mackie commented that something has to be a big problem and also the intervention has to have good chance. This is a big problem and she's also right that one needs to be able to intervene with a low mortality and again the British EVAR trials - the Endovascular Aneurysm Repair - have shown in multi-centre that it's possible to achieve a 1.7% mortality risk by doing - for correcting these aortas in patients who would otherwise die from a rupture. BARCLAY Professor Greenhouse thank you very much for joining us. WHITE More calls. Reg Williams is calling us from Newport. Reg, good afternoon. WILLIAMS Good afternoon. WHITE Yeah, what was the point you wanted to make? WILLIAMS Well I'd like to bring to the debate the situation with men and prostate cancer. You're obviously aware of the breast screening for women but we seem to be in this continuing debate about PSA testing for men and the prostate cancer. With a record of my father dying from cancer, I was in hospital looking at - suspected of having cancer, four years later at 55 to be told sorry because I went along and had a test, just by random, your PSA is 105 you've only got five years to live. The whole situation with prostate cancer screening is totally wrong and the issues of the studies that have been going on now for over 15 years I believe the data is corrupt because I wasn't told before I went for a PSA test that I shouldn't do any activities, strenuous activity, or any sexual activity because it affects the readings that you get. And when you're talking of such a low number like two, three, four in your PSA depending on the age of men if you're out working in your garden for a weekend laying a patio for instance your PSA would go up. Now ... WHITE So you're saying, if I understand you right, that screening - far more sort of blanket screening early on would detect this kind of thing? WILLIAMS I'm absolutely convinced of that and men I deal with in our group are convinced that if they had the opportunity to go and have tests done they would do that. I accept that men worry but that is - when you're told you've got cancer and you're going to die your family and yourself have got a lot more worries then. WHITE Can I bring in Dr Anne Mackie on this because there are debates aren't there about the effectiveness of if you like random screening with a condition like this. MACKIE It's certainly the case that the - looking at prostate cancer through the National Screening Committee's criteria it doesn't fulfil the criteria and the difficulty is that the prostate specific antigen - the PSA test, the caller was talking about - isn't a very good predictor of whether you actually have cancer or not. And then it is possible to have a little cancer in your prostate that you would die with rather than of, it is not a particularly good test. And I'd like to return to some things we were talking at the beginning and Simon Griffin talked about, we need to balance the benefits and harms for an individual. WHITE But that's quite a hard thing to say someone like Reg Williams, who finds himself in a situation where had he known what the risk factors were for him he could have done something more about them. MACKIE Sure and there is a programme where you can go and get yourself - have a PSA and you're given the advice about what the test means and what it doesn't mean and the risks associated with having it. So it's not that it's being denied, it's just that it's not a good screening programme, it's not something we should be offering to people who don't think they're at risk because it's not a sufficiently good discriminator of whether you actually have prostate cancer or not. We will make a lot of people anxious to no avail by applying this across the population. But he's also right that we continue to try and find a good screening test for these common problems. BARCLAY And we're getting e-mails on that subject. Eddie says: Resources, money, should be diverted from women's health centres to men's healthcare to make the funding 50/50. How about a national screening programme for bowel cancer, heart disease etc. aimed exclusively at men, especially working class men who rarely if ever go to the doctors? The sexism is astounding here - he says. Well the Prime Minister wants the NHS of the future to prevent and detect diseases before they take hold but are there good practices in other parts of the world that we should be following or that we can learn from? Dr Angela Raffle is a consultant in public health and responsible for delivering screening programmes for cancer in and around Bristol. She's also co-author of the book Screening Evidence and Practice. Angela Raffle, how does the UK compare with the rest of the world? RAFFLE Well I first got involved in screening in the 1980s and we were in a bit of a mess then. But ever since then things have really led the world in the UK. I've spoken at conferences and been involved in meetings from a number of different countries and the achievements that we've made in terms of producing evidence in having sound policy making and when we do do screening we do it in national quality assured way, so everybody gets a very high standard. BARCLAY Is there nobody we can learn from? RAFFLE The - some of the Scandinavian countries are excellent, Australia and New Zealand have some very good practice and a lot of people team up the world over to share knowledge, share experience. Many European countries now are trying to adopt a model like we have in the UK. BARCLAY But you have been particularly critical of the American system, what's wrong with the system which currently gives healthy people annual health checks? RAFFLE The Americans started the annual health examination in the 1920s and then the research came about in the 1950s and '60s showing that actually that was producing no benefit at all when you compared people who were having them with people who weren't. So the rest of the world learnt from that but by then it was a very - it was part of the culture in America and there's a whole industry that depends on it. So there's a big pressure to keep persuading people they need these checks with celebrity endorsement and it's highly inefficient as well. BARCLAY And presumably if, of course, those checks were removed it would cause such an outcry as not to be worth it. RAFFLE Absolute outcry. I mean when I'm teaching I always check with my group - is anybody from America - because their whole approach to annual medical checks is so different, you have to respect that and recognise that. BARCLAY Well can you give us an example of where money is being wasted? RAFFLE Well in the 1980s when we started getting interested in breast screening the American system obviously every clinic had to get a mammogram machine and within a few years they had four times as many as they needed to screen their entire population. So in order to recoup the investment they have to advocate it more frequently and on wider age ranges than the evidence supports. BARCLAY So there are lessons to be learned, things we should and shouldn't do from around the world. Dr Angela Raffle thank you. WHITE Back to the calls and Trevor Holbourn is actually calling us from hospital I think, Trevor, in Hull, good afternoon. HOLBOURN Good afternoon to you. Yes, yes that's correct I'm in hospital at the moment, I was involved in two local screenings last year, one for three A which was negative and the other one which is a North East screening screen for bowel cancer which proved to be positive. And within a very short time I was in hospital, had the tumour removed and now I'm back in having the temporary ileostomy repaired. WHITE And you say it was a routine screening, I mean how .. HOLBOURN It was routine, I didn't ask for either of them. WHITE So was it available at your surgery or how did you find out about it? HOLBOURN Well they both came through the post, the first one was a letter that asked me to do some self tests - laying on the floor and holding my stomach. And then I was asked to go to my surgery at a particular time where there was someone there with an ultrascan. But the bowel cancer wasn't done through the surgery at all, in fact it was all done by this local programme which is running in the North East of England. WHITE But you feel, obviously, very fortunate that this pointed out - which you otherwise would not have known about. HOLBOURN Not at all, no, I had no signs at all, I wouldn't have known about it, I would still be walking about with it and I was very fortunate they caught it early enough, they think, to prevent it recurring. WHITE We hope so, good luck Trevor, thanks very much for your call. And Charlie Bloom is calling from near Southampton, Charlie good afternoon. BLOOM Good afternoon to you. I found the last case to be very reassuring. My own particular circumstance is that there is a history of bowel cancer in my family - my father died of it in 1954, my mother had polyps removed, my sister has just had an operation to remove a section of her colon. Several years ago I went and saw my doctor and based on my family history a colonoscopy was performed, polyps were found and the NHS now performs a colonoscopy every five years to make sure that I am clear. WHITE But of course in your case, as you say, you are talking about where there's a clear family history, would you like to see that extended, given the debate we've been having about the effectiveness of rather more random screening? BLOOM Absolutely. I think that what killed our parents is quite likely to kill us as well, there must be a predisposition to it. But I think that to - for one of the doctors who was talking earlier to say well those at most risk are least likely to turn up I think perhaps that maybe something that the medical profession needs to look at and the more assertive in their dealings with their patients and make their patients understand more what is likely to happen to them and I do appreciate that men are worse patients than women in that regard - we don't like going to doctors. WHITE Can I bring in Dr Griffin about that because I think it was you that made the point, I mean what about that - that in fact if we're going to take a policy which is looking towards improving public health we have to be more assertive about the people who are or who maybe at risk? GRIFFIN Well I think that's an interesting point of view. I think that the people who are likely to attend screening, as we've already heard, are the ones who are most worried and least likely to have the condition. In the case of Charlie he had a strong family history and the test he underwent - the colonoscopy - is not without its risks. If you were to invite everybody of Charlie's age for a colonoscopy then you'd cause several people to perforate their bowel as a result of the - as a consequence of the procedure. But only a small proportion of them are likely to benefit. So I don't think we should be that assertive in forcing people to attend for screening because it is a judgement, it's a balance. Now what people need is the information on which to make that judgement and that's why we need studies comparing groups of people who undergo screening with groups of people who don't undergo screening and then see that there is this net benefit and then we can provide people with the information. WHITE I want to try and fit in a couple more callers. Deborah Stockwell is ... STOCKWELL Hello. WHITE Hello Deborah, what was the point you wanted to make? STOCKWELL The point I wanted to make was that I absolutely agree with screening as a life saver and certainly as a good wake up call. However, with GP surgeries now opening usually between nine and five Monday to Friday for those that work it's not something that they easily take up. My thought certainly is that you should take the mobile screening centres to places where people are working, whether it's factories, office blocks, town centres, railway stations etc. And they do that with the breast screening centres down here in Hampshire where they have mobile vans where they come along, we have an appointment, we have our breasts examined, we then get the results ourselves and it also goes to the GP, so it's certainly something that could easily be arranged. Hearing what the other gentlemen are saying I absolutely agree that men are not good at taking up offers of screening. We all have Well Women clinics around the country, we have very few Well Men clinics, this is something that should be encouraged. I personally feel my husband is over 60 - prostate, stools and also the abdominal ultrasound are excellent processes to actually eliminate or certainly to raise awareness. WHITE Deborah, thank you very much. I want to fit in one man, given the view that you've just expressed. Tim Riley from Rutland. Tim, what's your view about this? RILEY Good afternoon. Rather cynical to some extent. I'm married to a doctor so I've been listening to this sort of thing for 25 years and her colleagues as well. But I come from a - I suppose a fairly lateral position, I'm concerned about the diagnosis aspect and what I do see here is the hand of government behind this in terms of reducing costs now and waiting times and my real concern and having talked to my wife about this over the years and her concern and her colleagues at consultant level is - is there going to be an element of screening beginning to replace diagnosis. WHITE But it can't be wrong to want to cut costs can it because if you cut costs you treat those people who need help more? RILEY I agree and that was my second point. I think in terms of budget if one can prevent anything in life it's usually cheaper than dealing with the fallout once it's happened. But that would come on to my third point which I think is related in terms of the efficacy of this and I think the female doctor made this point about it's like a computer it's as good as the information you get out is as good as you put in. And often the very ill don't come to you. So - but I do have the suspicion though that - my wife, in fact, has had breast cancer three times and screened and on all three occasions they missed it and so did the junior doctors but a colleague, who wasn't even an oncologist, spotted it straightaway, he was a surgeon. So I do have this concern that with screening there could be a government push to have screening and to replace perhaps a one-to-one with the doctor who should be trained to diagnose this obviously in association with screening as well but basic diagnosis I think should be there and I think it's a downward spiral for doctors as well which is a view held by a lot of consultants .. WHITE Interesting points and my diagnosis is you did well to get three points into a minute. BARCLAY Well I've just been doing a straw poll you could say of our calls and e-mails and texts and we seem to have a fairly even split between people who say that there must be a better way than blanket screening and others who say that it saves lives and should be more widely available. Jean says: I don't think it would be a good idea to introduce as a blanket measure as it would cost so much money and divert attention from the sick and the needy. And another comment is: The breast screening cut off point is 60 yet you can still get cancer after this point. It costs a lot of money yet the number of cancers detected by this are low, it's not cost effective. But Elsie says: My 40 year old has a history of clear cervical smears, no symptoms of anything untoward, a smear test last year found a problem, prompt treatment may well have saved her life. And there's other people saying the same things. But Rosemary says: We must be aware of the dangers of screening. She believes that her breast cancer was caused by the scan. Nobody wants to put anybody off from going for their screening but Dr Anne Mackie is there a situation - a possibility - that perhaps screening can cause a problem rather than solve it? MACKIE I think - heavens - the ... WHITE You always get the tough ones at the end Anne. MACKIE I think that's very unlikely yes. It is certainly the case that something like the radiation dose associated with whole body scans will no doubt raise the lifetime risk of having cancer. The National Screening Committee programmes are very carefully introduced, I mean we are extremely careful to balance the risks of benefit and harm and I think actually if there's a message from the callers today which has been really helpful is that screening is a balance of benefit and harm and we need to be very careful to get that absolutely right. BARLCAY Dr Simon Griffin, would you agree with that summation? GRIFFIN Absolutely, I think the main harms associated with screening are anxiety, distress, having to go to the doctors and then perhaps having unnecessary tests or unnecessary treatments. Those are the main risks. I think the other thing to bear in mind is that focusing all our efforts on screening, looking at the very end of the distribution, the highest risk people, should be done complementary to prevention for the whole population. If everybody ate a bit less salt, if everyone moved about a bit more, if everyone changed their diet then we'd reduce heart disease far more than by screening for the highest risk people. So we need a balanced approach. And in fact Gordon Brown did make reference to this in his speech. BARCLAY And there we have to leave it. Thank you to Dr Simon Griffin, to Dr Anne Mackie and to all of you who called and also to the callers and e-mailers who didn't manage to get their comments made on air. Back to the Transcripts homepage Back to the You and Yours homepage The 麻豆约拍 is not responsible for external websites

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