It’s time to tell women the facts
A version of this commentary appeared in the Globe and Mail, Vancouver Province and the Huffington Post
When first introduced four decades ago, breast cancer screeningwith mammography was widely regarded as an important tool inthe fight against this terrible disease. It seemed obvious that theearlier it could be diagnosed the more lives could be saved. Aggressive treatment, it was thought, would prevent the cancer from spreading through the body. A huge amount of researchevidence since then has slowly and painfully led to a differentconclusion.It is now clear that the benefits of screening mammography havebeen greatly exaggerated and the serious adverse effects all butignored in the enthusiasm to support breast screening programs.It’s time for these programs to be reconsidered.It must be emphasized that this is the case for population screening of healthy women, not those with extra high riskfactors.This is a very unpleasant message for modern developed societies where three generations of women have been ledto believe that regular mammograms will save their lives and where an enormous related industry has been built up,but it is time to face the facts.Unscientific opinions and powerful vested interests abound on this subject, so it is essential to focus on well-conducted studies from independent sources to summarize the evidence. One of the most trusted of these, theCochrane Collaboration, has been studying screening mammography intensively. Their most recent bulletin statesthat the benefit of screening 2,000 women regularly for 10 years is that one woman may have her life prolonged. Of the other 1,999 women, at least 200 will have false positive mammograms leading to biopsies and surgery, and atleast 10 women will be falsely diagnosed with breast cancer and consequently subjected to unnecessary surgery,radiotherapy and chemotherapy.This problem, called over-diagnosis, occurs when a biopsy reveals microscopic cells that are currently labeled as“cancer” by the pathologist, but with uncertain potential to cause any significant problem for the patient in the future.The “c” word inevitably causes fear and distress for the patient and an aggressive treatment plan from the doctors.
This is now widely recognized, even by the USA National Cancer Institute which has recently recommended thatthese uncertain “cancers” should instead be labeled “IDLE” (indolent lesions) until research can help us differentiatethose that need treatment from those that do not.Now we’ve more evidence. The Canadian National Breast Cancer Screening Study published this week in the BritishMedical Journal, and widely reported in the international media, solidly confirms that there is no upside to breastscreening healthy women in terms of mortality benefit in exchange for the downside of all the adverse consequences.In this study, 90,000 women aged 40-59 were randomly allocated to the mammography screening program or toannual physical examination only, with follow up to 25 years. The mortality was the same in both groups (500 in thefirst group and 505 in the second).