General health checks in adults - Cochrane review

General health checks in adults for reducing morbidity and mortality from disease is an interventional review recently published by the Cochrane Library.  The aim was to determine whether general health checks do more harm than good, emphasising patient-relevant outcomes such as morbidity and mortality. Health checks were defined as screening general populations for more than one disease or risk factor in more than one organ system. The authors noted that general health checks are unlikely to be beneficial as they did not reduce morbidity or mortality, overall or for cardiovascular or cancer causes, although the number of new diagnoses was increased.  

Norman Swan interviewed the lead author, Lasse Krogsboll, on ABC Radio National's Health Report about this last week.  You can read the transcript or listen to the podcast here.

Krogsbøll LT, Jørgensen KJ, Grønhøj LC, Gøtzsche PC. (2012). Cochrane Database of Systematic Reviews, Issue 10. Art. No.: CD009009, DOI: 10.1002/14651858.CD009009.pub2

Oral health reports

The Australian Institute of Health and Welfare has released two new reports on oral health care, using data from the 2010 National Dental Telephone Interview Survey:

Families and their oral health provides information on the oral health and oral health impacts experienced by Australian children and seeks to determine if this experience is closely related to the oral health of their parents. Additionally, the report explores the role family circumstances play in children's experience of oral health. 

Chronic conditions and oral health reports on the impact of oral conditions on people with a chronic condition including asthma, cancer, heart disease, diabetes, arthritis, stroke, kidney disease, high blood pressure and depression. The report found that people with a chronic condition were more likely to experience toothache, be uncomfortable with their oral appearance, avoid certain foods due to oral problems and to experience orofacial pain. They were also more likely to have fewer than 21 teeth, making it difficult to chew food. 

Ward rounds - best practice guidelines

Ward rounds in medicine: principles for best practice has just been published by the Royal College of Physicians with the Royal College of Nursing.  It sets out core recommendations and principles for best practice for conducting medical ward rounds, including their structure, preparation and scheduling, as well as patient participation and protection, nursing involvement, the use of safety checklists and discharge planning. 

It calls for the multidisciplinary team – doctors, nurses, pharmacists, therapists and allied health professionals – to be given dedicated time to participate, with clarity about individual roles and responsibilities during and after ward rounds.  

Australian Clinical Trials website

Patients suffering chronic diseases will benefit from the launch of a new website that offers easier access to clinical trials of new drugs, treatments and medical procedures. Minister for Health, Tanya Plibersek recently launched the Australian Clinical Trials website in response to the needs of consumer groups, the pharmaceutical industry and research institutions. 
 
The website includes explanations of the clinical trial process; contact details for trials; a section for trial sponsors; real stories from patients, doctors and researchers, and a section for researchers on ethics, legislation and getting started.

Palliative care services in Australia

This inaugural report on palliative care services in Australia provides detailed information on the national responses to the palliative care needs of Australians.  Details from a range of data sources for 2009-10, and where available 2010-11, are presented, as are changes over time.

Since 2000-01, the number of palliative care separations reported in public and private hospitals has increased by 51% to almost 56,000 in 2009-10, and almost $3 million in MBS benefits was paid for palliative medicine specialist services in 2010-11. Over the 5 years to 2010-11 the amount of benefits paid on palliative medicine specialist services subsidised through the MBS has more than doubled.

There were 172 specialist palliative medicine physicians and 5173 nurses working principally in palliative care in Australia in 2009.

Landmark study on IV fluids

A landmark study by Australian and New Zealand researchers, CHEST (The Crystalloid vs Hydroxyethyl Starch Trial) has found that a widely used starch fluid for resuscitation of patients in intensive care units provides no clinical benefit and its use results in increased acute kidney failure (haemodialysis) when compared to normal saline.

Published in the New England Journal of Medicine, the study randomly assigned 7000 patients who had been admitted to an intensive care unit to either the starch fluid or the normal saline. The primary outcome was death within 90 days. Secondary outcomes included acute kidney injury and failure and treatment with renal-replacement therapy.  The results of the trial showed that, in patients in the ICU, there was no significant difference in 90-day mortality between patients resuscitated with 6% HES (130/0.4) or saline. However, more patients who received resuscitation with HES were treated with renal-replacement therapy.

Myburgh, J.A. et al “Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care” NEJM October 17, 2012DOI: 10.1056/NEJMoa1209759

BreastScreen monitoring report

The Australian Institute of Health and Welfare has just released BreastScreen Australia monitoring report 2009-10.  BreastScreen Australia aims to reduce illness and death resulting from breast cancer through organised screening of women. This report is the latest in an annual series that presents national statistics monitoring the program against performance indicators. More than 1.3 million women in the target age group of 50-69 were screened in 2009-2010, a participation rate of 55%. Breast cancer mortality is at a historic low, at 43 deaths per 100,000 women.

Population Health Research Network (PHRN)

The Population Health Research Network (PHRN) has been stablished with the backing of the Australian Government (as part of the National Collaborative Research Infrastructure Strategy) and is supported by every Australian state and territory.  The PHRN will enable existing health data from around Australia to be brought together and made available for health and health related research purposes. Health care planners, providers and policy makers will be able to use this research to respond more effectively to the changing needs of the Australian population.

Healthy lifestyle workers' web resource

A new on line portal to support Australia's Healthy Lifestyle Workers was recently launched by the Australian Indigenous HealthInfoNet.  Healthy Lifestyle Workers are employed across Australia as part of the Australian Government's Closing the gap - Indigenous chronic disease initiative.   The resources on this site The resource aim to provide the healthy lifestyle workforce with access to quality information, including key facts, publications, resources, programs and organisations on a range of topics such as tobacco use, nutrition, physical activity, diabetes, and kidney health.

Mental health services in Australia

Mental health services in Australia - in brief 2012 provides an overview of the national response to the mental health needs of Australians. It includes information on mental health service provision, available mental health resources and the changes that have occurred in these over time.

Estimates from the 2007 National Survey of Mental Health and Wellbeing (SMHWB) suggest that 7.3 million Australians (45% of the population aged 16–85) will experience a common mental disorder (a mood disorder, such as depression; anxiety or a substance use disorder) over their lifetime. Each year, 20% of the population in this age range, or 3 million Australians, are estimated to experience symptoms of a mental disorder. The second National Survey of People Living with Psychotic Illness conducted in March 2010 (Morgan et al. 2011) estimated that almost 64,000 people in Australia had a psychotic illness, most commonly schizophrenia, and were in contact with public specialised mental health services each year.

Health statistics for NSW

Health Indicators for NSW, authored by Talina Drabsch and published by the NSW Government, contains a selection of health statistical indicators in New South Wales and aims to provide a snapshot of health trends.  There is a focus on the overall picture in NSW, with breakdowns by local health districts, and, where relevant, comparisons with other Australian States and Territories.  Topics include statistics on births, life expectancy, disability, death, substance use, mental health, immunisation, health expenditure and hospital separations.

Private Lives 2: the Second National Survey on the Health and Wellbeing of Gay, Lesbian, Bisexual and Transgender (GLBT) Australians

Private Lives 2 (PL2) is a report on the second national survey of the health and wellbeing of gay, lesbian, bisexual, and transgender (GLBT) Australians. The first Private Lives (PL1) was released in 2006 and was, at that time, the largest survey of its kind conducted anywhere in the world. In 2011, 3,835 GLBT respondents successfully completed PL2. PL2 was an on-line survey publicised, nationally, and backed up by some hard copies of the survey which were distributed to GLBT seniors organisations across the country. The questionnaire consisted, primarily, of forced-choice (quantitative) questions but included a small number of open-ended or qualitative questions. The authors are William Leonard and others.

The project was supported by beyondblue with funds from The Movember Foundation, with additional funds provided by the Victorian Department of Health and a La Trobe University faculty grant. The project was managed jointly by Gay and Lesbian Health Victoria (GLHV) and the Australian Research Centre in Sex, Health and Society (ARCSHS) La Trobe University. (APO 30/4/12)

Footprints in Time - the Longitudinal Study of Indigenous children (LSIC)

The study aims to improve the understanding of, and policy response to, the diverse circumstances faced by Aboriginal and Torres Strait Islander children, their families and communities. The Footprints in Time study was conducted by the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) under the guidance of the Footprints in Time Steering Committee, chaired by Professor Mick Dodson AM. The study aims to improve the understanding of, and policy response to, the diverse circumstances faced by Aboriginal and Torres Strait Islander children, their families and communities. (APO 18/9/12)
The study was broken up into three waves:
Wave 1: topics include family life, growing up strong, learning and doing, and strong souls and safe communities.
Wave 2: Changes in family life structure and new topics such as child support, stolen generations and pre-school.
Wave 3: This report uses a measure called the Level of Relative Isolation (LORI) to describe the geographical characteristics of families in the study

Addressing Uncomfortable Issues: the Role of White Health Professionals in Aboriginal Health

This research by Annabelle Wilson investigated the role of white health professionals in addressing Aboriginal health in South Australia. Set within the discipline of nutrition and dietetics and the area of obesity prevention, it explored the practice of White health professionals from the point of view of Aboriginal and White workers. This research, currently in the form of an unpublished Doctor of Philosophy thesis, arose from practice dilemmas the author experienced as a dietitian working in rural and remote South Australia. The setting for this research was the eat well be active Community Programs, a community-based, childhood obesity prevention program in South Australia. In order to conduct ethical research, the author worked closely with Aboriginal community members and workers, through building and maintaining relationships and activities of reciprocity.

This research identified that there are a number of elements to the practice of White health professionals that make it ideal when they are working with Aboriginal communities. However, such ideal practice does not always occur and this research sought to identify why. The organisation, profession and individual were identified as systems within the wider system of Aboriginal health. In summary, this research identified that moving forward in Aboriginal health requires White health professionals to look at themselves, which generally requires them to address uncomfortable issues. (APO 11/10/12)

Supporting Older People who are Experiencing Mental Distress or Illness

The Benevolent Society has released the seventh in its series of community aged care Research to Practice Briefings.  Briefing 7, Supporting older people who are experiencing mental distress or illness, reviews Australian and international research evidence on the symptoms and treatments of mental illness in older people to provide guidance for community care practitioners in their day-to-day work of supporting older people. Mental distress or illness is not a normal part of ageing.  However, like people of any age, older people can be vulnerable to mental illness. This Briefing was developed in partnership with the National Ageing Research Institute (NARI). (APO 30/08/12)

Consumer Participation in the Health System

The following 2012-13 Victorian  Auditor General report provides details on consumer participation within the Victorian health care system. Consumers should be meaningfully involved in decision-making about their healthcare and treatment, and broader health policy, planning and service delivery. There is genuine commitment and effort from the Department of Health, and health services,  to facilitate meaningful consumer participation. The department has led implementation of consumer participation through strong policy direction and this has translated into appropriate policies, systems and activities in the four audited health services. Implementing consumer participation is relatively recent and a challenging process, and health services do not always provide sufficient staff training, resources or support to integrate consumer participation across their organisation. Consequently, achievements both between and within health services vary. (APO 10/10/12)

Women and Food

This discussion paper, Women's Health Issues Paper No. 8, explores various aspects of women’s health relating to food. These include the impacts of nutritional deficiency, the links between nutrition and chronic disease, women’s roles in relation to food, how a woman’s relationship with food affects her psychosocial health and the socio-economic factors that impact on access to nutritious food. Controversy exists in public health and health promotion about the approach and key messages that should be adopted in relation to food-related behaviours and body size to promote ‘health’ and prevent illness for women. It outlines various perspectives in this discourse and highlights some principles for managing health risks of public messages. It  was compiled by Bronwyn Upston from Womens' Health Victoria. (APO 9/10/12)

Targeting Brain, Body and Heart for Cognitive Health and dementia prevention

This report, by Alzheimer's Australia, looks into the current research regarding dementia and Alzheimer's disease prevention and offers ideas for possible future solutions. Prevention of dementia is the ultimate aim of a large, albeit under resourced, international research effort. The success of this effort would have enormous benefits for millions of people and save billions of dollars in health care costs. Conversely, the status quo will see the number of Australians living with dementia soar in coming years. Many more people will experience and seek help for mild cognitive impairment. There are many different forms of dementia, a syndrome caused by brain disease and characterised by declining cognitive function that impairs daily activities.

Dementia can affect memory, language, attention, judgement, planning, behaviour, mood and personality. Mild cognitive impairment does not significantly impair daily activities, but often represents an earlier stage of cognitive decline. There is no cure for the common forms of cognitive decline and dementia, including the most common, Alzheimer’s disease. A cure may only be achieved by prevention, because the diseases that cause dementia begin many years before symptoms become apparent and gradually damage the brain until it can no longer function normally. Intervening early to stop or slow disease progression, before cognitive impairment emerges, offers the best hope of preventing dementia. The disease can now be detected by brain scans or cerebrospinal fluid tests in the preclinical stage, before any cognitive changes occur.  (APO 30/9/12)

Investigating General Practice and Hepatitis B

There is an increasing burden on the community resulting from chronic hepatitis B infection. General Practitioners (GPs) are essential in reducing this burden given strong evidence showing that the early detection, follow-up and treatment of chronic hepatitis B can slow the progression to liver failure and reduce the chance of being diagnosed with liver cancer. The Australian National Hepatitis B Strategy 2010-2013 describes ‘general practice as part of a healthcare team... central to the healthcare experience of people living with chronic hepatitis B.’ Given indications of a less than optimal response to chronic hepatitis B by GPs in Australia, this study conducted qualitative interviews with 26 GPs to identify their understanding of their role, and perspectives on the barriers and challenges to the effective diagnosis and management of chronic hepatitis B in general practice. Authors: Jack Wallace, Behzad Hajarizadeh, Jacqui Richmond and Stephen McNally from the Australian Research Centre in Sex, Health and Society - La Trobe University. (APO 28/5/12)

Child Dental Health Survey Australia 2007

This report, "Child dental health survey Australia 2007 30-year trends in child oral health", describes the state of oral health of Australian children examined by school dental service (SDS) staff in 2007. It also describes trends in oral health of Australian children between 1989 and 2007. The most recent findings are drawn from the 2007 Child Dental Health Survey (CDHS) which analysed the data of 110,014 children aged 4 to 15 from most states and territories. The longer term trends highlight results for children aged 6 and 12 as these are the standard age groups for reporting on dental caries experience in the deciduous and permanent teeth respectively. Due to missing data from Victoria, any comparisons with previous years or international statistics should be made with caution. The figures presented over 30 years are drawn from previous CDHSs and monitoring undertaken by the (then) Commonwealth Department of Health.  (APO 29/5/12)

Smart Technologies for Older People

Addressing the challenges faced by an ageing population, this report discusses how smart technologies can support older people to remain in their homes. It is a systematic review of smart technologies that promote health and wellbeing of older people living at home from the Institute for a Broadband-Enabled Society (IBES). Australia has an ageing population. In 1901 the average life expectancy in Australia was 47 years. By 2025 it will be over 80. In 2050, 25% of Australians will be aged over 65, with 5% over 85. The growing number of older Australians leads to increased demand for aged services in health, social support, transport and housing. The effects of population ageing are enduring, placing increasing pressure on budgets to meet future demand. Lead Author, Professor Meg Morris, Head of School of Physiotherapy is aware of the problems and warns, "We will not return to the young populations that our ancestors knew."

The Smart Technologies for Older People report surveys the current literature on the use of smart technologies to support ageing across the globe adding a valuable resource to the policy debate. Smart technologies can support older people by promoting independence, quality of life and wellbeing. Smart technologies support delivery of a range of products and services over devices such as tablets, phones, computers, TVs, virtual reality "gaming" systems, and sensor networks. Additionally, smart technologies allow for the delivery of telemedicine services to older people, prolonging the period they can remain living at home.

The Cost of Inaction on the Social Determinants of Health

The cost of government inaction on the social determinants of health, leading to health inequalities for the most disadvantaged Australians of working age, is substantial. This was measured in terms not only of the number of people affected but also their overall well-being, their ability to participate in the workforce, their earnings from paid work, their reliance on Government income support and their use of health services. Substantial differences were found in the proportion of disadvantaged individuals satisfied with their lives, employment status, earnings from salary and wages, Government pensions and allowances, and use of health services between those in poor versus good health and those having versus not having a long-term health condition. Improving the health profile of Australians of working age in the most socio-economically disadvantaged groups therefore would lead to major social and economic gains with savings to both the Government and to individuals.  This report was prepared for Catholic Health Australia by the National Centre for Social and Economic Modelling. (APO 4/6/12)

Evaluation of NHMRC data on the funding of dementia research in Australia

The aim of this report is to provide the evidence base for evaluating the level of expenditure by the National Health and Medical Research Council (NHMRC) on research funding (including research, people support and infrastructure) related to dementia, in comparison to research funding for other areas of chronic disease. The report was commissioned by Alzheimer’s Australia to support a submission to the McKeon Review of Health and Medical Research in Australia in March, 2012.  (APO 30/5/12)

National Guide to a Preventive Health Assessment for Aboriginal and Torres Strait Islander People

This second edition of the guide  prepared by the Royal Australian College of General Practitioners is an up-to-date, evidence-based national resource created to help all health professionals delivering primary health care to Indigenous people. The use of this guide may help to prevent disease, detect early and unrecognised disease, and promote health. It contains Indigenous-specific information on:

• lifestyle factors (including smoking, overweight/obesity, physical activity, and alcohol)
• health among specific populations (child health, adolescent health, and the health of older people)
• chronic conditions (cardiovascular health, rheumatic heart disease, respiratory health, kidney health, diabetes, and cancer)
• infections conditions (sexual health and bloodborne viruses)
• other health conditions (oral health, eye health, ear health, and mental health). (APO 18/5/12) 

Indigenous early childhood development. New directions: mothers and babies services

The Australian National Audit Office has conducted an audit which has examined the effectiveness of the Department of Health and Ageing’s administration of New Directions, a program aimed at improving child health and education in Indigenous communities.
The audit considered whether:

• planning processes were developed to support the program’s objectives and rationale;
• implementation arrangements were clearly defined and aligned to the objectives of the program; and
• robust performance management arrangements had been established and were in use by the department.                       (APO 29/5/12) 

Families with Multiple and Complex Needs

This report by the Department of Human Services is a Best interests case practice model - Specialist practice resource. People with complex needs may have to negotiate several issues in their life, such as physical or mental illness, substance abuse and disability. They may be living in deprived circumstances and lack access to suitable housing, employment or meaningful daily activities. Each individual with multiple and complex needs has unique concerns tied closely to the interaction between his/her social, economic and health care needs, and so requires an individualised response. Within child protection and family intervention work, the phrase ‘multiple and complex needs’ can be used to refer to families presenting with circumstances and behaviours that are having negative consequences for family members, particularly children. (APO 23/8/12)

A review of opioid prescribing in Tasmania: a blueprint for the future

This review of the evidence, by the National Drug & Alcohol Research Centre, on opioid medications in Tasmania, and also nationally and internationally, has brought up a number of important observations on the changing landscape in Schedule 8 (S8) opioid medication availability, prescribing, and the changes in the regulation of these potent medications that have occurred in Australian jurisdictions and internationally. In Section One, the review of the international and national literature identifies consistent and substantial increases in opioid analgesic prescribing across a range of developed nations since the early 1990s. Increases in prescribing have occurred in Tasmania since the late 1990s, with a six- to seven-fold increase in prescribing authorities for opioids over a 12-year period.

There is growing concern both internationally and locally about the harms associated with these drugs amongst chronic pain patients, and about extra medical use and diversion. These concerns are based on peer reviewed studies of opioid-related deaths and other harms amongst chronic pain patients and injecting drug users (IDU), primarily in the United States; are shared by a number of medical practitioners and other health professionals in Tasmania; and are borne out by the analysis of Tasmanian and Australian data in Section Two. (APO 25/7/12)

The role of supervisory neglect in childhood injury

This paper, from the Australian Institute of Family Studies, explores the theoretical understandings of supervisory neglect and how these understandings might assist in delivering practical responses using a public health approach to child protection. Children are vulnerable to different types of injury depending on their stage of growth and development. Children will also need varying degrees of supervision depending on their exposure to a range of risk and protective factors.
Key findings:

• There is no universally accepted, all encompassing definition of the concept of "neglect", and consideration of supervisory neglect suggests that there is no "one size fits all" definition.
• Supervision can be a complex, resource-intensive activity when undertaken at its maximum effectiveness - understanding and evaluating what comprises "good enough parenting" remains subjective and is difficult to evaluate.
• Identification of neglect should pay heed to parental competence and/or caregiver capability, cultural context, child personality and level of maturity, and environmental risk factors.
• The need to forecast where future harm may arise from a lack of appropriate supervision is paramount.
• Impoverished families living in "poor" neighbourhoods may be unable to provide adequate nutrition, medical care or education for their children not because of a lack of recognition of the child's needs or a want to do so, but because of a lack of access to resources.
• Exposure to one type of harm (such as neglect) increases the risk of exposure to other forms of harm (such as physical or sexual abuse). In a child protection context, if children suffer a number of injuries this may serve as a warning that there are other issues of a potentially neglectful nature.  (Authors: R. Franklin, D. Higgins, D.Scott) (APO 6/9/12)

Addressing fetal alcohol spectrum disorder in Australia

This report contains an overview of fetal alcohol spectrum disorder in Australia, including the health and social impacts of alcohol use during pregnancy.
The report also contains recommendations to address the condition, which include:

• implementing broad ranging social marketing campaigns to raise awareness of fetal alcohol spectrum disorder, and the risks to the fetus or baby if the mother consumes alcohol while pregnant and breastfeeding
• supporting health professionals and services through the development of national policy and clinical practice guidelines, as well as workforce development and training. (APO 6/6/12)

Alzheimer's Disease - causes and predictors

ABC Radio National's Health Report this week focused on Alzheimer's Disease, and research from the University of California Los Angeles (UCLA).
The first interview was with Dr Gary Small, professor of psychiatry and director of the UCLA Longevity Centre.  He talked about a way of identifying people who are still healthy yet may be at increased risk of developing Alzheimer's disease in the future, and therefore who might benefit from some intensive dementia prevention.  There are a couple of chemical markers for Alzheimer's in the brain, one of which is tau tangles.  Small and his colleagues have been studying these for some time, and have followed a group over two years with various interventions and controls.  Read the transcript or listen to the interview here.
The other interview was with John Ringman, who has been researching people who develop Alzheimer's disease quite young due to a genetic mutation, and what this tells us about the disease.  Ringman and his fellow researchers have been investigating chemical messages which could help with treatment and prevention of the disease.  The transcript or audio can be found here. 

Systematic review of hand hygiene strategies

"A systematic review of hand hygiene improvement strategies: a behavioural approach", by Huis et al, has just been published in Implementation Science.  Available on open access as a provisional pdf, the review looked at behaviour change techniques for hand hygiene categorised by determinant.  For example, increasing memory, or the understanding of information related to a 'knowledge' determinant, and providing opportunities for social comparison related to 'social influence'. The authors reviewed 41 studies and found that the most successful improvement strategies addressed combinations of different determinants such as knowledge, awareness, action control, social influence and facilitation.  One or two determinants addressed in the strategy is not enough to change hand hygiene behaviour.  

Implementation Science 2012, 7:92 http://dx.doi.org/10.1186/1748-5908-7-92  

Guidelines - adults surviving child abuse

Adults Surviving Child Abuse (ASCA) has published their new Australian guidelines 'The last frontier: practice guidelines for treatment of complex trauma and trauma informed care and service delivery'.

Funded by the Department of Health and Ageing, the purpose of the guidelines is to inform health professionals, workers and organisations about new ways of responding to trauma, in clinical practice and in health and human service settings. The guidelines aim to influence, advise and educate on treatment of complex trauma and the implementation of trauma informed care and service. This is the first time clinical guidelines for the treatment of complex trauma have been published, and they collate the last 20 years of national and international research.

HealthEngine - GP directory

HealthEngine Australia is an online directory of GPs across Australia.  It has been operating since 2006, but this year has expanded to include a real time appointment facility and other medical specialists.  You search by town or postcode, then a list of practices and available appointments comes up, ready to book.  There are limitations, as there still aren't very many practices listed with appointment times (especially in rural areas), and there are few specialist doctors listed in the directory, but it has the potential for growth and is handy for GP listings, especially if you find yourself in unfamiliar territory.

Breast screening - lives saved outweigh overdiagnosis

A Europe-wide review of breast cancer screening has concluded that the benefits in lives saved outweigh the risks of overdiagnosis. Reported in the  BMJ by Nigel Hawkes, the study carried out by a working group from nine European countries, showed that for every 1000 women between the ages of 50 and 69 who are screened, between seven and nine lives are saved and four women are “overdiagnosed.” The conclusion contradicts that of critics of breast cancer screening, who have argued that the number of women damaged by false positive findings exceeds the number who benefit by having their cancers detected earlier.

The original report of the study can be found in the Journal of Medical Screening, Summary of the evidence of breast cancer service screening outcomes in Europe and first estimate of the benefit and harm balance sheet" by Eugenio Paci.  J Med Screen September 2012 vol. 19 no. suppl 1 .  

Contact your health library for the full text of these reports.