Should women undergo screening breast cancer mammography at all?

Benefits and Harms of Mammography Screening

No, next question. Ok, ok, this is a personal choice issue and everyone should be allowed to make that choice themselves, but insurers should have to offer policies with and without these dangerous "preventative" procedures.

More after the break!

When Maddog discusses this issue with women in the US, the response is uniform surprise, as if what I am saying is new to them. These women believe screening mammograms are only positive, and offer no harm. Here is what the article authors say:

"Women should be unpassionately informed about the benefits and harms of mammography screening using absolute effect sizes in a comprehensible fashion. In an era of limited health care resources, screening services need to be scrutinized and compared with each other with regard to effectiveness, cost-effectiveness and harms."

Agreed. Inform, unpassionately, and fully, however, this is not possible for most physicians since they make money from these procedures. And an entire medical industry relies upon the continuation of screening mammogram, regardless of how injurious, and deadly to the women. 

How do other nations deal with this problem? 

"Mammography screening is recommended (and in Europe offered through organized programs) in most Western countries. However, in Switzerland an independent panel of experts (the Swiss Medical Board) reviewed the evidence on mammography screening and concluded that harms outweighed the benefits and recommended against mammography screening;[17] that is, that screening programs should not be implemented in areas where such programs do not exist and that the ongoing programs should be phased out."

Pressure to continue these programs is intense, and worsened by groups like Komen, who also have a huge, vested financial interest in maintaining the screening mammogram industry. 

The authors conclude:

"Conclusion

Women should be correctly informed about the benefits and harms of mammography screening (Figures 1 and 2). A comprehensible way of communicating information on benefits and harms of mammography screening is presented in Figure 1: among 1,000 women who start screening at age 50 and are screened for 20 years, 2 to 3 will avoid dying from breast cancer and 200 women will have at least one false positive test, 30 will undergo a biopsy, 3 will be diagnosed with an interval cancer, and breast cancer will be overdiagnosed in 15.

In an era of limited resources for health care and preventive services, we need to scrutinize our efforts in screening and prevention. One of the overarching goals of screening is the reduction of incidence or mortality of disease. Currently, we do recommend some screening services (such as mammography), while others are debated or discouraged (such as prostate-specific antigen screening for prostate cancer or aspirin for primary prevention of cardiovascular disease and premature death). However, as Figures 4 and 5 show, these differences in recommendations do often not reflect differences in effectiveness or harms between the different tests.[49,62]"

Please make sure you are informed, and understand the consequences of all preventative medical screenings before you undergo the procedure. Today, medicine has become mostly big business, and far less medicine, or art. The fact that over diagnosis to benefit in breast cancer mammography is 15 to 2.5 (2 to 3) is shocking. Far more women are injured than are helped. 

The problem we have today is that we cannot determine which women are more likely to be helped by screening, and which will not be helped. The result is the industry simply recommends screening everyone, and damn those injured. At the same time, we find we do not understand which cancers, can be successfully treated. Thus, we screen everyone, and treat all "cancers." In the end, this "shotgun" approach is injuring myriad, while helping few. 

Until we figure out who will directly benefit, and which cancers should be treated, women need to be extremely cautious about these procedures. 

More generally, we all need to be more cautious about medical, and cancer screening, it is never as simple as the physicians proclaim. Nor is it the panacea they so strongly declare.

Counterintuitively, the best way to avoid breast cancer is to not use mammography screening . . .