Breast cancer screening
BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5625 (Published 06 December 2017) Cite this as: BMJ 2017;359:j5625
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It is now time to take heed to calls for there to be a controlled deimplementation of screening by mammography. [1] [2] [3] Mounting evidence about harms and overdiagnosis, together with an increasing and pressing need to use both our financial and health professional resources wisely, without wastage, indicate a strong imperative for those responsible to take action without any further prevarication. Citizens are not being served justly or well by profligate spending on interventions that are demonstrably damaging both citizens and the public purse. Harms to citizens, both accepters and decliners, and those treated and untreated, are numerous, and have been well-documented.
How much longer do we have to go on waiting for those responsible to acknowledge that breast screening by mammography as now offered is not fit for purpose, is wasting valuable resources and harming more citizens than it helps? It is time, as suggested [1], for them to acknowledge that “the logical consequence of recent evidence is to start a discussion about controlled deimplementation of invited screening with mammography.”
[1] Mette Kalager `Breast cancer screening` BMJ 2017;359:j5625 http://www.bmj.com/content/359/bmj.j5625
[2] Autier P, Boniol M, Koechlin A, Pizot C, Boniol M. Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study. BMJ 2017;359:j5224. http://www.bmj.com/content/359/bmj.j5224
[3] Doublvetsky J V, Robert V, Nicot P, Bour C. Collectif Cancer Rose. Rapid response to [2] above. http://www.bmj.com/content/359/bmj.j5224/rr-1
Competing interests: No competing interests
"The bad news is that screening mammograms are unlikely to be responsible for that benefit, while causing well documented harm."
The good news is that mortality from breast cancer is falling due to improved treatments. More good news, at least for some women, is that mammography screening, an anxiety provoking and sometimes harmful procedure, can no longer be considered clearly advisable.
Many individuals suffer under the belief that "If only it had been found earlier things would have worked out differently."
Blame guilt and anger not infrequently arise. Evidence that challenges this belief system is evidence, not bad news.
Competing interests: No competing interests
False positive breast cancer results after 10 years of mammography screening range from 33%-50% of women. [1][2][3][4][5][8][9]
All consequent overdiagnosis anxiety, depression, suicides, attempted suicides, risky behaviours, injuries, biopsies, mastectomies, irradiation, chemotherapies, lymphadenectomies, morbidity, mortality should be considered as iatrogenic, and calculated in National medical error statistics.
Thus, up to 50% of the population of mammographically screened women can be jeopardized by medical errors.
Nipple secretion cytology tests and targeted endoscopic biopsies are also used for breast cancer screening.
Even attempting to obtain combinations of first and second opinion on breast cancer pathology slides from expert pathologists with a high volume of diagnostic work, results in mistakes in 10.9% to 18.0% of patients. [6]
In a recent analysis of all available studies, cancer screening has never been shown to “save lives”. [7]
Conclusions of the recent Swiss Medical Board report for abolishing mammographic screening [10] agree with Professor Mette Kalager's conclusions.
Unfortunately, women still tolerate errors during breast screening.
A series of lawsuits and multi-million dollar compensation claims for harms induced will speed things up towards the right direction.
References
[1] http://www.cochrane.org/CD001877/BREASTCA_screening-for-breast-cancer-wi...
[2] http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61216-1/fulltext
[3] http://www.bmj.com/content/339/bmj.b2587
[4] http://www.cancer.gov/types/breast/hp/breast-screening-pdq
[5] https://www.youtube.com/watch?v=8A9xuLmUHcQ
[6] http://www.bmj.com/content/353/bmj.i3069
[7] http://www.bmj.com/content/352/bmj.h6080
[8] http://jamanetwork.com/journals/jama/fullarticle/2040228
[9] http://annals.org/aim/article/2596394/breast-cancer-screening-denmark-co...
[10] http://www.nejm.org/doi/full/10.1056/NEJMp1401875
Competing interests: No competing interests
Re: Breast cancer screening
Why not screen women at risk only? The recent Danish study of 1.8 million women published in the NEJM showed relative risk increases of 20 to 38% for women taking oral contraceptives for up to 10 years. This included hormone related IUDs and the low dose pills and progesterone. 1 The more select the target group, the more likely the positive pick-up of cancers, and the less the collateral damage to innocent low risk women. Screening needs to be as safe as possible and as focused as possible to optimise its effectiveness, and limit its adverse effects.
1. Morch LS et al. Contemporary hormonal contraception and the risk of breast cancer, N ENgl J Med 2017; 377 ;2228-2239. DOI; 1056/NEJMMoa1700732.
Competing interests: I wrote a book called "The Screech Owls of Breast Cancer" showing that oral contraceptives cause breast cancer. I have also written many rapid responses pointing out the same causality and this is supported by the Danish N Engl J Med study of 1.8 million women.