Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The benefits of screening mammography have been greatly exaggerated

Charles Wright, MD
Conditions
March 4, 2014
Share
Tweet
Share

When first introduced four decades ago, breast cancer screening with mammography was widely regarded as an important tool in the fight against this terrible disease.  It seemed obvious that the earlier 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 research evidence since then has slowly and painfully led to a different conclusion.

It is now clear that the benefits of screening mammography have been greatly exaggerated and the serious adverse effects all but ignored 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 risk factors.

This is a very unpleasant message for modern developed societies where three generations of women have been led to 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, the Cochrane Collaboration, has been studying screening mammography intensively.  Their most recent bulletin states that 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 at least 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 that these uncertain “cancers” should instead be labeled “IDLE” (indolent lesions) until research can help us differentiate those that need treatment from those that do not.

Now we’ve more evidence.  The Canadian National Breast Cancer Screening Study published in the British Medical Journal, and widely reported in the international media, solidly confirms that there is no upside to breast screening 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 to annual physical examination only, with follow up to 25 years.  The mortality was the same in both groups (500 in the first group and 505 in the second).

Adverse consequences from screening can include false negatives (a cancer is growing but missed by the mammogram), and potentially cancer-causing cumulative x-ray exposure.  Not to mention the anxiety, pain and discomfort that women experience with the procedure and the huge cost of these programs to the health care system.

This new study, along with the Cochrane analysis, represent the beginning of a growing consensus among scientists and clinical epidemiologists that the evidence no longer supports population screening of healthy women with mammography. Several prominent female UK doctors have gone public about choosing not to have breast cancer screening, including the editor of the BMJ, the past president of the Royal College of GPs, and the professor of obstetrics at King’s College London.

Nobody can be happy about all of this disappointing news with its serious public, professional and political implications, but surely we cannot ignore it. The hope that breast screening could cause a reduction in the mortality from this terrible disease was at first well placed 40 years ago, but it is no longer possible to advocate for an intervention that carries such a tiny (if any) likelihood of benefit along with such a huge burden of harmful consequences.

The very essence of science is about seeking truth through the constant cycle of evidence, analysis and revision. In response to a hostile question, John Maynard Keynes famously remarked “When the facts change, I change my mind. What do you do, sir?”  We should heed that lesson here.

It may take a long time to dispel the false hope that has been given to women with mammogram screening, but the very least and immediate response should be the development of a mandatory consent form for women to sign before screening that distinguishes the most recent and overwhelming evidence from the current inappropriate enthusiasm. Women would then be empowered to make an informed choice.

Public health agencies should also consider a comprehensive plan for public re-education about screening mammography, followed by the gradual dismantling of population breast screening programs across the country.

ADVERTISEMENT

Charles Wright is a surgeon and former chair, Ontario Health Technology Advisory Committee.  This article originally appeared in Evidence Network.

Prev

I saw my intellectual exercise as something I hadn’t before

March 4, 2014 Kevin 0
…
Next

Whither the white coat and why

March 4, 2014 Kevin 1
…

Tagged as: Oncology/Hematology, Radiology

Post navigation

< Previous Post
I saw my intellectual exercise as something I hadn’t before
Next Post >
Whither the white coat and why

ADVERTISEMENT

More by Charles Wright, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Overdiagnosis: When health services harm more than help

    Charles Wright, MD

More in Conditions

  • What Elon Musk and Diddy reveal about the price of power

    Osmund Agbo, MD
  • Understanding depression beyond biology: the power of therapy and meaning

    Maire Daugharty, MD
  • Why medicine must stop worshipping burnout and start valuing humanity

    Sarah White, APRN
  • Why perinatal mental health is the top cause of maternal death in the U.S.

    Sheila Noon
  • A world without vaccines: What history teaches us about public health

    Drew Remignanti, MD, MPH
  • Unraveling the mystery behind one of the most dangerous pregnancy complications: preeclampsia

    Thomas McElrath, MD, PhD and Kara Rood, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • A world without vaccines: What history teaches us about public health

      Drew Remignanti, MD, MPH | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
  • Recent Posts

    • From Founding Fathers to modern battles: physician activism in a politicized era [PODCAST]

      The Podcast by KevinMD | Podcast
    • From stigma to science: Rethinking the U.S. drug scheduling system

      Artin Asadipooya | Meds
    • The gift we keep giving: How medicine demands everything—even our holidays

      Tomi Mitchell, MD | Physician
    • The promise and perils of AI in health care: Why we need better testing standards

      Max Rollwage, PhD | Tech
    • From burnout to balance: a neurosurgeon’s bold career redesign

      Jessie Mahoney, MD | Physician
    • Healing the doctor-patient relationship by attacking administrative inefficiencies

      Allen Fredrickson | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 42 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • A world without vaccines: What history teaches us about public health

      Drew Remignanti, MD, MPH | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
  • Recent Posts

    • From Founding Fathers to modern battles: physician activism in a politicized era [PODCAST]

      The Podcast by KevinMD | Podcast
    • From stigma to science: Rethinking the U.S. drug scheduling system

      Artin Asadipooya | Meds
    • The gift we keep giving: How medicine demands everything—even our holidays

      Tomi Mitchell, MD | Physician
    • The promise and perils of AI in health care: Why we need better testing standards

      Max Rollwage, PhD | Tech
    • From burnout to balance: a neurosurgeon’s bold career redesign

      Jessie Mahoney, MD | Physician
    • Healing the doctor-patient relationship by attacking administrative inefficiencies

      Allen Fredrickson | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The benefits of screening mammography have been greatly exaggerated
42 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...