- Steven Woloshin, professor12,
- Lisa M Schwartz, professor12
- 1VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont 05009, USA
- 2Center for Medicine and the Media, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
Like US Independence Day, Thanksgiving, and Christmas, disease awareness has made it into the US calendar. In 2012 we have 175 officially designated “national health observances,” including rabies day, sleep awareness week, endometriosis awareness month, and many observances for heart disease and a variety of cancers.1 None is more prominent than breast cancer awareness month, otherwise known as “October.” And no organisation has done more to promote this observance than Susan G Komen for the Cure, the world’s largest breast cancer charity and creator of the ubiquitous “pink ribbon,” which each year aims to “turn the country pink for national breast cancer awareness month.”2 3
Komen’s portfolio of activities includes a variety of laudable efforts “to save lives, empower people, ensure quality care for all, and energize science to find the cures.”4 But the charity is best known for promoting mammography screening.
Unfortunately, there is a big mismatch between the strength of evidence in support of screening and the strength of Komen’s advocacy for it. A growing and increasingly accepted body of evidence shows that although screening may reduce a woman’s chance of dying from breast cancer by a small amount, it also causes major harms.5 6 In fact, the benefits and harms are so evenly balanced that the National Breast Cancer Coalition, a major US network of …