In a Muddle About Mammograms?

As all of our female readers know, breast cancer is one of the leading causes of premature death in women.  We’ve also been brought up to believe that annual mammographic screening, unpleasant as it is, significantly reduces our risk of dying from breast cancer.

So, it may come as a surprise that mammography screening is now one of the greatest controversies in healthcare.

Those who are unconvinced of the risk:benefit profile of mammograms believe that researchers have sacrificed sound scientific principles in order to arrive at politically acceptable results.

Even neutral observers increasingly feel that the benefits of screening have been oversold and that the harms are much greater than previously believed.

A new book by Professor Peter Gøtzsche entitled Mammography Screening: truth, lies and controversy is certainly going to add further fuel to this already heated debate. Gøtzsche, who heads up the Nordic Cochrane Centre in Copenhagen, has repeatedly published on breast screening over the last decade.

Even those who have been following the debate over breast cancer screening will be surprised by the degree of acrimony, personal attack and bad statistics described by Professor Gøtzsche.

Sure, there have been professional arguments over screening before, but this takes it to a whole new level.

He demonstrates that the evidence on which breast screening programs were set up was inadequate and concludes that breast screening probably doesn’t work.  According to him, the benefits – if any – are marginal and the harm is great.

He also describes the hostility he and his team have been subjected to during their decade-long research in the area. Attacks have come from three groups:

  • disinterested experts
  • oncologists who have spent their careers recommending mammograms
  • those who earn money in the $1 billion screening industry

All in all, this book is painful reading to those of us who believe that research is all about the science. Gøtzsche claims that when there is emotional investment, it becomes harder to disentangle risks and benefits clearly. As a society, we have become attached to screening, despite evidence demonstrating how marginal the benefits and how frequent the harms.  He claims that the lure of ‘catching it early’ and the emotive hard sell seems to have circumvented the usual rigorous review of the evidence.

And he’s not alone.  A few years ago Professor Michael Baum, a surgeon who was involved in setting up the breast screening program in the UK, wrote the book Breast Beating, in which he described the personal cost of opposing the unrelenting push for more screening.

He also criticized the UK’s Breast Screening Program saying:

“Whatever the number, that one woman who benefits from a decade of screening has a life of infinite worth and if screening were as nontoxic as wearing a seat belt there would be no case to answer. However, there is a downside to screening, namely the problem of the overdiagnosis of “pseudocancers”.  For every life saved ten healthy women will, as a consequence, become cancer patients and will be treated unnecessarily. These women will have either a part of their breast or the whole breast removed, and they will often receive radiotherapy and sometimes chemotherapy.”

Following this, an independent review of breast screening in the UK was announced. The review is hoping to answer two fundamental questions: firstly, if it is worthwhile to continue at all, and secondly, if women should be, as they currently are, encouraged to have breast screening or – more simply and more ethically – to consider whether they would like it.

Writing in Pulse Today, Dr Margaret McCartney, a GP in Glasgow suggests that if more women read Professor Gøtzsche’s book, they too would decide not to be screened. She goes so far as to predict that in a few decades, doctors will look back on breast screening with the same raised eyebrows that they currently reserve for Reiki.

To screen or not to screen?  That is the question.  Let us know what you think.