Education And Debate

Women need better information about routine mammography

BMJ 2003; 327 doi: http://dx.doi.org/10.1136/bmj.327.7406.101 (Published 10 July 2003) Cite this as: BMJ 2003;327:101
  1. Hazel Thornton, honorary visiting fellow (hazelcagct@aol.com)1,
  2. Adrian Edwards, reader2,
  3. Michael Baum, emeritus professor of surgery3
  1. 1Department of Epidemiology and Public Health, University of Leicester, Leicester LE1 6TP
  2. 2Department of Primary Care, University of Wales Swansea Clinical School, Swansea, SA2 8PP
  3. 3Academic Department of Surgery, University College, London W1P 7PL
  1. Correspondence to: H Thornton, Saionara, Rowhedge, Colchester CO5 7EA

    Scientists continue to argue about the benefits of breast screening, but ultimately decisions about screening should be made by women themselves. To make this decision, however, women need to fully understand both the benefits and the potential harms

    Although mammographic screening is well established in the United Kingdom and elsewhere, its value continues to be debated. Most of the data on mammographic screening come from a group of clinical trials completed over a decade ago. These are subject to constant reworking, reanalyses, and wrangling between the screening zealots and the screening sceptics. New data are unlikely to emerge, as it is improbable that new screening trials, with a control group that is “left to nature” will be conducted.



    Embedded Image

    Decisions about mammographic screening should be based on all the facts

    Credit: CHRIS PRIEST/SPL

    Most of the controversy surrounding screening, however, seems to miss the point. The question of whether the benefits of screening outweigh the harms is essentially a value judgment. The problem is that, up to now, this judgment has been made by paternalistic agents of the state rather than by women, supported by their general practitioners or others. In order to make an informed choice on screening, women need to be aware of the range of uncertainties for both the benefits (that is, preventing death from breast cancer) and the harms.

    Evidence of effectiveness

    Public health programmes such as the UK NHS breast screening programme aim to reduce mortality from breast cancer by offering routine mammography to healthy individuals. This is a potential public good. But the public receives highly conflicting messages about the effect of screening. Every new published estimate is hotly debated in the media, and the results are usually couched in terms that most people will misunderstand. The latest report of a “44% reduction in breast cancer mortality in …

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