Slicing The Salami (and calling it steak).

I am taking a brief respite from the 'Loss of Innocence' saga, to excoriate about the publicity for the study about the intake of meats causing Cancer. Much was made of this in the print and broadcast media with precious little criticism or adverse comment from, well anyone. But in truth it was like most of these proselytising studies, that attempt to steer us from the path of our demise by feeding us the results from 'scientific' research that is not really scientific at all.

The study, published in the Archives of Internal Medicine is an observational study, which means it is not presenting any evidence, merely drawing conclusions from data provided by food frequency questionnaire's filled in by the cohort every four years! I can't even remember what I had for dinner last Tuesday, except to know it would have had meat in it; probably lots of it. These epidemiological type studies are really the starting point of a hypothesis to test it's credibility. They are not the end point, merely the beginning of a journey that should encompass all of the checks and balances that science should pursue to ensure that any statement made about anything should at least be founded in proven fact. So, is it likely that the cohort from whom the data was drawn, reported the facts of their diet without telling a few little lies? I really think not, but that's a side issue really.

Let us then look a little deeper. Firstly we see that all meat, processed or otherwise so long as it's red, is alarmingly 'lumped' together, although they do within the study provide some separation of the two and indeed indicate that 'processed' meats are more harmful than other types. But looking further we find that the actual questionnaire lists hamburger meat as 'unprocessed'. You can read about the reliability of Food Frequency Questionnaires here. This highlights the tendency for the cohort to over report socially acceptable foods rather than those they have been 'brainwashed' to reject, but nonetheless still consume. It may also not escaped your attention, that it is the same Institution that also produced this study. Ironic? I could not comment.

So 'hamburger' meat passes for red meat in the US. And to some extent, if you want to give credence to any of this rubbish then remember that the cohort is entirely comprised of US citizens. There is meat, and then there is American meat most of which is 'lot fed' in corrals most of it's life and fed on concentrates of soy protein, cattle corn and antibiotics. It's no longer meat as we know it! Europeans although consuming meat of this type in small amounts, generally eat grass fed beef and lamb, the latter of which is a large part of their 'red meat' diet.  So if this study proves anything (and I don't think it does) it proves that eating US meat and all the other elements of the diet, of those who filled in the Questionnaire, could possibly, maybe, cause Cancer. Of course there are numerous confounding factors that go unreported such as, what other elements of the diet examined might be contributory to the conclusions about Cancer? All of the cohort may have also drunk vast amounts of alcohol or worse, coke! They may have all been drug addicts for all we know, because it is unreported.

Looking then at the science, about the higher reported incidence of Cancer in those who ate lots of processed meats. There is a mechanism that could be responsible, and again it's something that predominates more in the US than Europe or the UK, and that's nitrites. They are an additive used in the preservation of hams, sausages, bacon and continental sausage. Sodium Nitrite (E250) is used to add colour but more to prevent the growth of the bacteria Clostridium Botulinum, the cause of botulism.

When man started to preserve meat, natural sea or rock salt and air drying were the main agents, but as we became frightened of salt and to speed up processing we began using chemicals. Preserving salts today have the addition of 0.6% sodium nitrite or the potassium version to guard against botulism because we now turn around the processing of meats so quickly that it is much more probable, well not really (anymore) but it does make the product nice and pink. Many long matured air dried 'artisan' sausages do not need it and it's a good idea to avoid it if possible. It is not much of a poison the Lethal Dose 50% (LD50) is 71mg per kilo for humans but nitrites form nitrosamines, which are carcinogens, if they are heated in cooking at high temperature. The highly acidic environment of the human stomach can also bring about the same condition. So it is usual, and a legal requirement in the US, to add ascorbic acid (Vitamin C) at 550 ppm to preserved meat or any meat treated with nitrites. The acid inhibits the formation of nitrosamines and in fact the incidence of stomach cancer fell significantly in the US after its addition to preservation methods.

It is a good idea not to roast ham or fry bacon so that it is charred or too crisp, or to limit intake. If one does eat bacon crisp, which is the way most like it, then take a Vitamin C supplement, it helps to prevent Cancer anyway and is rarely harmful. Alternatively eat high quality processed meats that do not have nitrites, although you may have to go to some lengths to find them. Nitrites can also be found in many green vegetables and root vegetables especially, so you do not want to overload on these either. Lettuce, Spinach and Radishes contain the most and a significant proportion of this can be attributed to the use of nitrate fertilisers. The more mature the plant the lower the level of nitrite. Organic vegetables are usually lower in nitrites than those grown by the multinational growing cartels.

A rare result of over consumption can bring about methaemoglobinaemia, which robs the haemoglobin of its oxygen absorption capabilities and causes hypoxia (oxygen starvation). But one would have to consume vast amounts of nitrites for this to come about and most cases are due to other causes. Again an intake of Vitamin C is both the treatment for this rare disorder and is protective against nitrosamine being formed from nitrite ingestion. Most animals produce their own Vitamin C to combat this but a few, including man lost this ability at some time in the evolutionary chain. And to get enough of this vitamin, drinking orange juice will not cut it I'm afraid. Orange juice is flavoured with err... orange flavouring, because natural orange flavour only lasts hours. So, the processors have to add it back to the packs and bottles it comes in, otherwise it's orange water. Man cannot get enough from diet of this vitamin in today's nutritional environment unless we supplement or eat targeted foods high in its content with watercress being one of the best. However, most green leafy vegetables including cauliflower provide substantial amounts, but yes are also high in.....nitrites! Oh, just take a pill!

 So eating preserved meats does have a mechanism that could be causative of some cancers, because it does actually exist, but frankly you would have to eat really large amounts, on a regular basis. And, the bun surrounding the 'unprocessed' burger meat (sic) is likely to be more harmful. And what country is renowned for it's consumption of burgers and barbecued meats? Might that be the country of origin of the cohort of this study, the USA? Always remember, long suffering reader, that observation (and correlation) does not prove causation.

Loss of innocence (part four) continues shortly.

Health Misogyny

Health care in general and the NHS in particular, places far too much reliance upon the notion of prevention and 'early' detection of disease, or rather the 'markers' of what is assumed to be a possible or maybe disease, or condition. This particular trait, and it is redolent of all health care models throughout civilisation, is directed more at women than men.

Perhaps the concept of women being fragile, vulnerable to all sorts of ailments diseases and conditions, that are either particular to, or more predominant in their sex than males, is where this founded. And, of course when this process of labelling all women as potential harbingers of their own doom came to pass, it was men who set about building the edifice of treatments, allocated specifically to the 'fairer' sex, to save them from their 'treacherous' hormone ravaged bodies. And what a crock of s**t, it has all turned out to be.

Mammograms, Cervical Smear Tests, Hormone Replacement Therapy, Vaccines targeted for Cervical Cancer, 'Medicalisation' of Pregnancy, Osteoporosis treatments (mainly for women) and the general consensus that women need 'protecting' from the ravages of their own predisposition to ailments arising from their femininity. Men and some women, are unable to resist the urge to prod, poke and peer into the extremities of women simply to reassure themselves, and vulnerable women, that all is as it 'should be'. A whole industry in Medicine and Health care has sprung from this, including the desire of men, often imposed upon women, to aspire to a stereotype image of the size 10 with big breasts and shapely bottoms. Culminating of course in the Breast Augmentation, Reduction and Botox protocols that has spectacularly 'gone wrong' in the case of the PIP debacle.

I have written at length about Screening for Breast Cancer in the past and  more evidence has comes to light about it's futility for most, and the lie perpetrated that many are 'saved', when in fact the so called cancer found, is not really 'cancer' at all. And it would have likely responded to 'watch and wait protocols' rather than going in with the knife, radiation and chemotherapy. The 'treatment' of Ductal Carcinoma In Situ (DCIS) is redolent of this mindset. Studies conducted also continue to find that mammography seems to increase the incidence of breast cancer than reducing it. The main problem is however that women are treated as pawns, and deprived of the information needed to make an informed decision about whether or not, to submit to this 'testing' (sic) protocol.

Cervical Smear Tests are also 'sold' to women as essential to health and whilst there is little harm invoked by them, when an abnormality is detected the 'system' once more tends to 'overtreat' and frighten women into interventions that can be counter productive. Firstly the incidence of cervical cancers is quite low at 2.4 per 100,000 (European age standardised mortality)  and certainly screening young women (up to 30 years) has been shown to be of little worth. The trend also has been been downwards for the past thirty years (from 7.1). As the mortality rate for Prostrate Cancer is rising and  close to 10x  higher at 23.9 per 100,000 it seems strange that this is not targeted, when Cervical Cancer is. But of course 'overdiagnosis' is really the problem in oncology, especially for treatment protocols directed at women and it continues, without abatement.

We now have the HPV vaccine, targeted (again) at young women to prevent cervical cancer and genital warts yet the vaccine (Gardasil/Cervarix) is only admitted as being effective against two strains of the Virus (types 16 and 18) and there are allegedly thirty strains that are cancer promoting. As the target cohort is 11 to 13 years old females (although now men are now being targeted too!) prior to likely sexual activity and protection is only afforded for ten years at most, it seems perverse to leave them without protection in the years when activity is likely to be elevated, so is it worth it? Even of course if you even think that the vaccine is any good in the first place, which viewing the evidence it seems not, to me. I personally feel that the whole concept of an 'epidemic' of HPV infections is pure hype to sell an unproven vaccine, mainly to women, for their daughters, to swell the coffers of  'Pharma' at a time when the 'blockbuster' drugs are coming off patent. Do young girls need a pretty useless vaccine for a relatively easily treated disease of very low incidence? Make up your own mind, your informed mind. This JAMA editorial may help.

And what of HRT? It was proffered as the panacea for menopausal symptoms and the retention of 'youthful vigour' in women of a certain age and although for many it did precisely that, it exacted a price; breast cancer. Even with short term use, risks of both cardiovascular disease and thromboembolism were also increased tremendously and the ovarian cancer risk increased in the oestrogen only cohorts by some 60% (relative risk). Except for extreme cases, it is used rarely for menopausal symptoms today, but that did not stop 'Pharma' from reaping tremendous profits, from an ill conceived and dangerous drug that is now seen as being counterproductive despite its benefit for the prevention of osteoporosis (but not treatment).

Way back in history we had thalidomide, that was targeted at women to eliminate or ameliorate the problems of 'morning sickness' in pregnancy. As most will know, it wreaked terrible havoc with lasting and appalling effects, but now new information is coming to light about a virtually forgotten drug called Diethylstilboestrol (DES) which seems to cause a rare form of cancer of the vagina and cervix called 'clear cell adenocarcinoma' or CCAC, in the second generation .The Independent on Sunday of today, has highlighted this, but the story has been around for some time with $1.5bn paid out already to victims. Surprisingly, this drug is still used in the UK (but rarely) under the 'Apstil' brand for prostrate cancer and advanced breast cancer in post-menopausal women. (Another crock of s**t?). It was another drug invented for the 'medicalisation' of pregnancy.

It is quite rare in fact for any women to have a home birth. They are taught to fear this in case of complications and the need to ensure their offspring are 'safe'. The truth is in fact that home is a much safer place than hospital, as many of us will know, when we went to hospital for one problem and ended up with many more. The following are some interesting statistics.

	Births (  percent of total )		Perinatal Mortality ( per 1000 births )
	1958	1970	1958	1970
Hospital	49	66	50.1	27.8
GP Unit	12	19	20.3	6.1
Home	36	12	19.8	4.3

 ( Statistics resulting from 1958 and 1970 perinatal surveys in Britain. Sources: Sheila Kitzinger, Homebirth and Other Alternatives to Hospital, and Marjorie Tew, Journal of the Royal College of General Practitioners, August 1985.)

Prospective mothers will be told that they are putting their baby 'at risk' if they stay at home for their birth, and I would be the first to advocate that any at risk should be hospitalised, but for healthy women, especially in their second pregnancy, with no known risks, it is cheaper, safer and less traumatic for mother and baby. Yet a whole industry has grown up in the NHS to foster the idea that no other protocol should be countenanced.

Women are continually treated as if to be female is an illness in itself and that your whole life has to be conducted under the microscope of the Health care Profession. Many of the ailments that women are heir to have their risk inflated out of all proportion to reality. many, as I have pointed out are very low; much lower than many that are completely ignored by medicine. We continue along the road of epidemiology and genetics as twin pillars of research but it is a blind alley, especially for women, who have suffered more than men in this construct of blaming their ills upon hedonistic lifestyles, stupidity, and poverty. Most if not all of the breakthroughs in medicine have been due to luck more than insight. Failed aspirations are in fact the predominant factor in Health care, and the 'expert committee' the death knell of common sense.

To treat women as the 'milch cow' of medicine is patronising, condescending and it is without doubt misogyny. Doctors and Clinicians should cease this continual search for things they can 'invent' to fill in their time before their wealth laden retirement. Perhaps they have; children. But that must wait for another day.

By writing this post I could perhaps be accused of the sin I am trying the exemplify. I really hope not.

Phones, Breasts, and Vaccines.

The report on the dangers of using mobile phones has been published in the BMJ, and frankly it tells us very little. The cohort sample did not include those who use them for business, who would be the heaviest users, one would think. So not to include these users is a glaring error surely, as in most things, dose dependency would be a significant element of any dangers.  Considerable heterogeneity in the cohort sample also leads one to the belief that significant factors unrelated to mobile phone use, could be at play or simply that those with a subscription may not even use their phone or use it infrequently or with some device that moves it from their head. This study then proves little and reinforces the tenet in scientific study that 'correlation (and observation) does not prove causation', or in this case does not prove any absence of harm. My advice then, for what its worth, is to avoid prolonged conversations, use some form of earpiece to move the mobile away from your brain, and eliminate their use by young children.Oh and wait for some real evidence of any lack of harm, before you drop your guard.

Breast Cancer is again in the news with further evidence of the harms attendant on Mammography Screening. The cited study highlights the increased liklihood of 'false positives' in line with the frequency of mammograms. And the recent Swedish Study reports that screened women had a higher incidence of breast cancer than did those who were not screened and of course the study, published in the 'Lancet' has a pay wall, except for the abstract. Is it any wonder then, that women have little information of an unbiased nature available to them, when this important study is virtually hidden from view, with little or no publicity attached. So the impossibility of informed choice continues. Mette Kalager's  comment in the same journal is telling. Is it not time that the facts were presented to women so as to enable them to discern dogma from fact?

Vaccines rear their dubious benefit once more now the 'flu season is with us once more. Health Professionals (sic) are entreating all over 65, pregnant women and the vulnerable to get their 'jabs'. I have to confess that I don't do it  (there's a surprise then) because I feel it to be worthless. The vaccine offered is not comprehensive for many 'flu strains nor is it tested fully for safety, so I'll take my chances, keeping my Vitamin D3 levels high. Recent studies  have shown little effect for vaccines for the elderly or indeed for those less so.  To be frank, I would be loath to give these vaccines to anyone. They are symptomatic of the interfering nature of the state to govern our health by diktat or worse, 'nudging', without any foundation of the intervention as having value. Most are ( in my view) worthless or even dangerous.

I am capable of acting in my own best interests and I do not need the ambivalent support of the State to guide me toward the best outcome for me. So I told the GP, when he 'hounded' me, as to why I hadn't taken up their generous (and incentivised) offer of a 'flu vaccination, to read the science, and politely suggested that he was just trying to fill the quota and thus get the money. I was astounded when he actually agreed. I think that some Doctors are as much victims of the system that tries to turn citizens into a vulnerable client of the state bureaucracy of health as are we all. Not that I view that as an excuse. Just 'following orders' has never been a worthy defence, even for a Doctor (sic).

Screening for Cancer Fails to Prove its Worth.

I have talked at some length about Breast Cancer Screening  before, and accused those involved to be more interested in perpetuating the myth that 'screening saves lives' than in providing facts for women to make an informed decision. Well, the clamour is getting louder for 'real information' to be available for this and other screening protocols and what are the advocates doing to quell the disquiet? Closing their eyes, ears and more importantly their mouths.

The recent study in the BMJ showed clearly that screening (mammography) is not responsible for the reduction in Breast Cancer mortality seen in six Eurpoean populations. In fact, in a few of these countries, mortality was reducing prior to any screening protocols being in place. The response of the screening lobby   ( a powerful vested interest), has been resounding silence, to these obvious negative inputs to the argument. Displaying the trait it seems of the 'three wise monkeys', as Richard Smith  explained on his BMJ blog.

Screening for Bowel Cancer too has been having some bad press as the relative risks are presented as absolute in the leaflet provided to the prospective cohort (including me). In truth the risks are quite small and the relatively 'crude' methods involved in screening lead to many false positives, waits for confirmation, and much unneccessary treatments, investigations and, the attached risks of harm involved in colonoscopy are actually higher than the likelihood of Colerectal Cancer (much higher at 1 in 150) and the risks of  procedure causing perforation and the consequent risk of pertonitis is 1 in 1500. Risk of death is pretty low at 1 in 10,000, but that is close to the absolute risk anyway, which is less than 1 per 1000 in ten years of screening.

Mitzi Blennerhassett, wrote in Macmillan blogs about the dearth of information, and indeed the bias of that available and she is (thus far) a survivor of colerectal and breast cancer, so she talks from the frontline. The replies to the BMJ about the study also make fascinating reading, with much criticism of the lack of evidence and indeed the arrogance portrayed by most in the 'business' (for that is what is) when questioned as to the efficacy of mammography or indeed most forms of cancer screening.

The NHS spends vast amounts on these protocols, allegedly to save us from 'harm' and an untimely end, but fails consumately in simple areas of diagnosis of illness in so many patients, treats the elderly with appalling disdain, even cruelty. Is lacking in 'adequate out of hours' trauma provision. Trains Doctors to be patently less good at the job than in the past, then 'throws' them into the maelstrom of A&E with little or no mentoring or backup. When scientific evidence is presented that indicates that a drug or procedure is harmful, especially Primary interventions for prevention using 'surrogate markers' or end points, rather than a patient actually being ill, they ignore it!

Prof. Michael Baum with others, ( 3 pages of them) wrote to the Sunday Times about this lack of information and the virtual conspiracy of silence that exists around the harms, way back in 2009. He was ignored. He wrote again recently but that's behind a paywall now so I can't post that link. The signatories are seeking  a judicial review of the screening programme because they are so incensed by the lack of information and potential harms it causes. The conspiracy of silence continues with evidence stacking up in the aisles that we do little to end the tyranny of Cancer but much to find it, where it doesn't exist and even more to treat it with questionable drugs and procedures that may in fact add to it's virulence. A scientifically informed choice is what is needed and an NHS dedicated to curing the sick and the lame, and giving comfort to the dying, not that which we have now.

Counting the Harms (and the cost),

I hold the view that the NHS is responsible for considerable harms. The cost of those harms, both financial and in lives, are often overlooked by the populace, because they hold to their bosom's a number of myths about disease, and how it can be avoided by 'screening'. That protocol is more of a political imperative than one borne out by the science. Cancer is one of these. We all want to believe that the NHS can save us from a terrible termination of our lives by 'catching' this scourge of contempory existence, in it's early stages and thus saving, or at least prolonging our lives. We are deluded. And it is 'bosoms', probably most of all, where screening concentrates it's efforts.

Breasts, define the difference between the sexes, perhaps more than any other element of  appearance and they are an emotive indicator of feminism, much admired by men and cherished by women, whose fear of breast cancer and the loss of that essential feminism, seems to be a real and present danger. But, that is largely a myth. Incidence is in fact between 1 and 2 per 1000 per year, dependent upon whether you are pre, or post menopausal. In fact 80% of detected breast cancer occurs in women over the age of 50, so this cohort is the most at risk. However, if we compute that into a ten year risk analysis, then 994 women out of 1000 will not get breast cancer.

Fiona Godlee in the BMJ of March 2006 questioned the ethics of screening and came to the conclusion that it was overstated for efficacy and 'over diagnosis' was a considerable failing of the system. This is reflected in the views of Professor Michael Baum in this critique he wrote in 2008, shortly after he resigned from the programme which he had helped to set up. Principal amongst his thoughts, are that screening does not cure anything it just detects asymptomatic disease; breast cancer, well maybe. But 'catching it early' does not devolve any cure, merely a postponement of the inevitable fate of us all, for a somewhat flawed paradigm of periodic testing, that in itself has unpleasant and somewhat dangerous implications for the recipient, with no gaurantee of longer or better life than would have been the case without it.

Mammography is the current test protocol for the early detection of abnormalities, which involves quite high levels of ionising radation, being delivered in several doses, to ensure an 'allegedly' complete picture of the breast. In fact the dose is equal to 1000x that from a standard chest X-ray, so there is some considerable dangers attached to screening in this manner. This holds true when pre-menopausal women are screened, as is the current plan (coming soon to screening centre near you), because the cumulative dose will increase significantly due to the longer screening periods. A dose level of 1 rad in total is often the case, so over time this can add up to a significant risk for cancer in it's own right. In fact the estimated risk of cancer from mammography was calculated, based upon a life total of 24 screenings, of the digital type (which uses a much lower dose than film screening, usually employed in the UK) that 8.6 women per 10,000 would develope cancer as a result of screening, in itself. That, I would add is not far short of the overall risk of 1/1000 of getting cancer anyway.

The Nordic Cochrane Centre has conducted extensive research on the subject and came to the following conclusions;-

 Absolute risk reduction for screening is 0.05%
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Screening led to an absolute risk increase of 0.05% due to a 30% overdiagnosis and overtreatment.


So, for 2000 women screened for 10 years, 1 (that's one) will have her life prolonged and 10 (that's ten) healthy women, will undergo unnecessary treatment including breast removal, chemotherapy and radiotherapy, for no useful purpose. The Centre has produced a leaflet which gives an unbiased and scientific evaluation of screening to enable women to make an informed choice, as opposed to the over emotional and biased view portrayed by the NHS and indeed most Physicians.

There have been many studies undertaken to prove or disprove the efficacy of mammography, and the results have been ambiguous a lot of the time, but the the Canadian Trials are viewed as being amongst the best and it is clearly stated that screening had no impact on mortality (post menopausal women 50-59). Here is the view from the Cancer Prevention Coalition in the US who have considerable reservations about it's outcomes and the forces at work that advocate it's use. And this riposte published in the The Lancet from February of 2002 looked at the attempts to 'rubbish' the Canadian and Malmo trials which, when evaluated showed no difference in mortality between screened and unscreened women (see here for more comment). Even the quite militant screening advocates, the US National Breast Cancer Coalition, indicate that screening only reduces the absolute risk by 0.07% ( in women between 50 and 65).


So at best we can hope for a very small, numerically insignificant reduction or no reduction, in breast cancer in post menopausal women, by mammography screening, for some extremely unpleasant side effects and a 10x higher risk of over diagnosis and treatment. Many cancers detected are in fact benign or self limiting and will regress if left or simply stay the same. We do much harm and very little good by screening and for women with breast cancer, a majority will have found it themselves and screening will have played no part, or worst the lump will have appeared between screenings. In other words screening finds very little vigorous tumours but is good at finding and treating cancers that are not usually life threatening. This skews the picture even more.

And what of cost to the NHS? Well around 2 million tests are undertaken each year and rising. The cost of the tests was £166 million (in 2008) but obviously more now. If we add in the re-tests, biopsy and operation and therapy costs so that we save one women in 2000 (in 10 years) but at the same time treat 10x that number who do not even have cancer, we are talking about £500 million or more. How can the NHS justify this enormous cost without having better outcomes? And why do women tolerate this appalling invasion of their bodies with all the attendant risks, amongst which is the fact that if they have already got cancer at testing, the 'squeezing' effect of the plates is likely to cause it spread much more quickly because of the force employed which is about 200 newtons (45 lbs).

Screening is not prevention, merely the detection of a marker for a given disease, or an actual tumour in the case of cancer. We 'sell' to women the view that we are preventing their untimely demise from cancer by screening, which is of course a complete lie.  It is in the interests of all involved in this 'industry' of testing that it continues and proliferates as it has done since 2008, when the 'saintly' Gordon (Brown) decided, without any scientific input, that he would fund a whole new paradigm of test protocols to enable the 'plebs' extend their life spans. As is usual Physicians and the NHS leapt at this opportunity for even more incentive payments to increase their wealth (and power).It reinforced the  utilitarian principles that have driven the Neo-Liberal doctrine since Tony Blair's ascendency and for all his heirs and sucessors including the tossers 'toff's' who now rule.

There are other alternatives for those who are particularly 'at risk' like the genetically disposed cohort, such as MRI and/or thermographic imaging, both of which are significantly more benign, or even entirely so. There is also considerable hope for a simple saliva test that will provide a non invasive test. There is also considerable evidence that maintaining sufficient levels of Vitamin D3 by exposure to sunlight (without sunscreen) can confer protection against breast cancer.

Well ladies, I have strayed into territory that many men would fear to tread, but I feel that you are all being manipulated by the emotional baggage surrounding this issue. Mammography is oversold and is wanting of evidence to justify both it's expense and it's outcomes. It appeals to the emotional attachment you have to a part of your body that feeds your offsprings, tantalises and fascinates most of mankind, and in many ways defines your femininity. It plays to the fears we all have of the 'big C' as John Wayne called it, and gives false hope for a dubious protocol that feeds an industry without morals, and an NHS that kills 25,000 people a year due to preventable adverse events ( Ian Kennedy's report of the  Bristol Heart Inquiry). Let us 'clean the stables'of that mess instead of  venturing into prevention strategies of little worth.






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