Mammography seeks to diagnose breast cancer earlier, with the hope that more timely initiation of treatment will lead to better outcomes. All this makes sense, but there are facts about mammography which do not make it the ‘no-brainer’ many doctors and researchers would have us believe it to be.
Claims are often made that mammography saves lives. However, you can read here about research which found that reductions in death rates on the introduction of mammography were actually smaller than those in areas where mammography was not offered to women. The implication here is that reductions in death on the introduction of mammography were nothing to do with mammography at all, but due to other factors such as improvements in breast cancer treatments.
And there’s something else that women need to know about mammography too: it very often leads to the detection of lesions that turn out to be ‘nothing’, as well as cancers that would not have troubled the women over their natural lives. As a result, many women are subjected to stress and unnecessary investigations and treatments. Sometimes, these treatments cost women their lives. This is most certainly not a trivial matter.
In recent years, some researchers and doctors have been keen to provide some balance to the mammography debate. They have called, if nothing else, for women to be given both sides of the mammography story, and for its deficiencies and pitfalls to be explained to women so that they can make more informed decisions about whether to attend for screening. However, in response to this, proponents of mammography have generally responded with intransigence, restating the supposed benefits of the practice despite the concerns about it.
The ante was upped again this week on the publication of a paper in the Journal of the Royal Society of Medicine written by two mammography researchers who, again, point to evidence that mammography’s true ability to save lives is dubious at best . The paper is critical of scientists attached to the NHS (National Health Service) Breast Screening Programme in the UK. The claim is that they are clinging to beliefs formed 25 years ago, despite good evidence coming to light which shows these beliefs to be scientifically untenable.
The paper also points out that new evidence regarding the ineffectiveness of mammography and the problem of over-diagnosis have not been reflected in an information leaflet for women published last year.
You can read here how Professor Peter Gotzsche, the paper’s lead author, claims:
“Senior researchers who are affiliated with the UK screening programme continue to distort the facts even though we, and others, have pointed out their errors.
“I can only speculate why, but when you have believed in something for a long time and your career is built on that belief, it is very difficult to change. These people, in a scientific sense, are behaving outright dishonestly and doing women a great disservice.”
Yet, the Breast Screening Programme here in the UK is set to be expanded.
In January this year I wrote a blog post which highlighted the fact that more than half of American women do not attend for scheduled mammograms. I speculated that at least some of these women have weighed up the facts (found on the internet, most likely) and decided it’s just not for them. Despite the intransigence of the British Government and many of the scientists advising it, I wouldn’t be surprised if we see a similar trend in non-attendance over here.
1. Gøtzsche PC et al. The Breast Screening Programme and misinforming the public J R Soc Med 2011;104(9):361-369