Margaret McCartney: Doctor's notes

· One in nine. After Kylie's announcement that she has breast cancer, young women are becoming alarmed. It's the statistic on the backs of buses, part of charity awareness drives and fundraising efforts, on leaflets and magazines. It's common parlance, and is quoted to me by young women worried by what they think they may be harbouring in their breasts.

Well, yes, one in nine women in the UK will get breast cancer: but you have to read the small print. To get to that level of risk, you have to live a long time. The small print says that this is the risk for a woman getting breast cancer if she lives to the age of 85. If you go and look at the details on the NHS breast-screening website, the data is laid out for all to see: up to age 25, the risk is 1 in 15,000: up to age 40, it's 1 in 200. The older you get, the bigger the risk. It's not zero risk, and we'd prefer if breast cancer didn't exist at all: but it's lower than we are often led to believe.

So younger women get it, albeit less commonly. What we often forget is the huge amount of emotional baggage that comes as we tell people to be constantly checking for cancer. Awareness gets muddled up with bad advice - for example, the advice to perform regular breast self-examinations is now discredited, but regularly wheeled out. Presently, the most proven advice is that women should be knowledgeable about their own bodies and seek prompt advice if they have concerns. If a few women get disproportionately worried about a cancer they don't have, that's hardly an issue, is it?

But of course it is. Cancer statistics are easy to come by, but I don't know anyone who is counting the deleterious effect of "awareness". Of course, women who have an abnormality they can feel should be promptly seen and assessed. But for other women, there is the subtler, enduring effect of worry when there are no symptoms at all.

Meanwhile, the women who are most likely to get breast cancer are older, and somehow "invisible". What we need isn't really awareness, but balanced, no-sensation, non-scary education. Surely we should be looking at how to get better, not necessarily more, information to women. The level of damage induced by introducing - even encouraging - anxiety about health does not belong to just those who are at high risk of cancer.

· Patricia Hewitt has made it clear that she intends to press full steam ahead with health-service reforms, with "choose and book" close to the beating heart. But why is choice always thought of as desirable? For those upwardly mobile people who are highly motivated to go and find out the latest in league table results and MRSA rates, they may wish to choose what looks good on paper. Meantime, those with little inclination to do so - or without a computer or internet access, or the time or ability to sort out the numbers - aren't going to. Rather than elusive, long-wait centres of great popularity, what we should really want are "good-enough" hospitals where no one is disadvantaged no matter where they go. And, Ms Hewitt, while we're here: the idea of using text messaging to pass on results of cervical smears might be feasible, but it is an overreaction to aim, as the pre-election pledge made out, to get results back to women within seven days. Is it not more important that results be done on the basis of accuracy, and not in a race to fulfil targets? In any case, cervical smears are designed to pick up pre-cancerous changes taking place over years, not days.

· The breast cancer drug Herceptin was hailed by the headline "instant cure-all" at the weekend, with suggestions that it should be immediately fast-tracked. So misleading, it's almost hilarious. If it works, of course we want it, but false hope is not kind. As anyone will tell you, the only certainties are to do with death and taxes.

Neither is such pressure to prescribe safe. A new book, Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises, by Richard Deyo and Donald Patrick - professors at the University of Washington - is now out in the UK. Doctors, scientists and patients are all far too keen on what is new rather than what is better, they say, before bemoaning the fact that the US Food and Drug Administration approves new drugs if they work at all, rather than assessing them against what is already available. In that regard, we at least have the National Institute for Clinical Excellence (Nice). Rather than see Nice as an obstacle to be overcome, we should see it as a safety net. Rather than bemoan its existence, we should be glad that we have it.

· The writer is a GP based in Glasgow.

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