Intended for healthcare professionals

Analysis Too Much Medicine

Overdiagnosis in mammography screening: a 45 year journey from shadowy idea to acknowledged reality

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h867 (Published 04 March 2015) Cite this as: BMJ 2015;350:h867

Re: Overdiagnosis in mammography screening: a 45 year journey from shadowy idea to acknowledged reality

A Societal Solution is required

Both Barratt [1] and Goetzsche & Jorgensen [2] describe the range of findings of various teams of investigators who arrive a widely different conclusions about both the ratio of harm to benefit and the degree of effect of mammographic screening on reducing advanced cancer.

Barratt (BMJ Talk Medicine), quoting Stacy Carter, reminds that these disputes about the effects and effectiveness of mammographic screening require a societal solution. Carter and colleagues affirm the need to draw both on evidential systems and ethical systems. [3]

Now that it has been comprehensively acknowledged that mammographic screening inflicts harms on asymptomatic women, it is time to acknowledge that it is morally wrong to inflict harm on them, particularly without fully and properly informing them. [4] And, more importantly, it is time to seek social solutions to rectify that assault.

Examination of reasons why we have arrived at this parlous state of affairs might sharpen the focus:

• Wilson and Jungner principles of screening not observed; (Forest Report)
• In UK, Edwina Currie`s introduction of population screening was naively under-informed and politically motivated;
• Repeatedly, the NHS Breast Screening Programme strenuously avoided all demands for insisting that women be properly and fully informed;
• Robustly produced systematic reviews of evidence were dismissed or ignored.

Most citizens, some health professionals and many politicians are ignorant of epidemiology`s methods of producing evidence. But now, many are instinctively wising up to the fact that there is Too Much Medicine and that people are being treated dishonestly and disrespectfully.

It is wrong to harm citizens; it is time to put a stop to it.

[1] Barratt A. Overdiagnosis in mammography screening: a 45 year journey from shadowy idea to acknowledged reality: BMJ 2015;350:h867

[2] Goetzsche PG, Jorgensen KJ. Screening doesn’t reduce the occurrence of advanced cancers rapid response to [1] 19th March 2015. http://www.bmj.com/content/350/bmj.h867/rr-2

[3] Carter SM, Rychetnik L, Lloyd B, Kerridge IH, Baur L, et al. Evidence, Ethics, and Values: A Framework for Health Promotion

[4] Sokol DK. Update on the UK law on informed consent. BMJ 2015;350:h1481

Competing interests: No competing interests

22 March 2015
Hazel Thornton
Honorary Visiting Fellow, Department of Health Sciences
None
University of Leicester
"Saionara", 31 Regent Street, Rowhedge, Colchester. CO5 7EA