Mammograms – have women been misinformed?
Some topics are holier than others. It seems that breast cancer screening is one of them. Although studies are pouring in showing that this type of screening could be at the best useless and at the worst harmful we still receive invitations in the mail for our “life saving” breast exams.
In March 2010 the renowned British Medical Journal published a Danish study showing that the Danish breast screening programme had no effect on breast cancer mortality. Another study published in the same journal in 2009 showed that one in three breast cancers detected in a population offered organised screening is overdiagnosed (over diagnosis referring to the detection of cancers that will not cause death or symptoms). One in three is a lot! What about all the women that undergo treatment for their overdiagnosed breast cancer? Adding to all these cases of overdiagnosis is the sad fact that breast cancer screening seems to only save limited number of lives as a study published in the New England Journal of Medicine in 2012 shows and Dr. David Newman, an emergency room physician in New York City, articulates brilliantly on in an article published in The New York Times in 2012.
In April 2014 an astonishing article was published in the New England Journal of Medicine reporting on a review of mammography screening conducted by the Swiss Medical Board in January 2013. (The Swiss Medical Board is an independent health technology assessment initiative under the auspices of the Conference of Health Ministers of the Swiss Cantons, the Swiss Medical Association, and the Swiss Academy of Medical Sciences). Their conclusion is very clear: “It is easy to promote mammography screening if the majority of women believe that it prevents or reduces the risk of getting breast cancer and saves many lives through early detection of aggressive tumors. We would be in favor of mammography screening if these beliefs were valid. Unfortunately, they are not, and we believe that women need to be told so. From an ethical perspective, a public health program that does not clearly produce more benefits than harms is hard to justify. Providing clear, unbiased information, promoting appropriate care, and preventing overdiagnosis and overtreatment would be a better choice”.
What will it take? Why are we still being told to have our routine mammograms and made to feel like we are irresponsible if we don’t? Should health authorities not be looking at implementing other options for prevention of breast cancer by now?