Has breast screening (use of mammography in a regular programme to look for breast cancer when there are no symptoms) become an unstoppable juggernaut? An article by H Gilbert Welch in the Los Angeles Times questions the continued use of breast screening programmes when these have been shown to cause more harm than benefit. The public understanding of ‘cancers’ is that they spread and kill, but many of the tiny (normal) changes found by breast screening do not even deserve the name ‘cancer’. Without screening they would remain hidden and never become a problem.
“Over time and over place, the findings are consistent: Screening is good at finding small breast cancers. Unfortunately, the small cancers it finds often seem to be those not destined to become large, deadly cancers,” writes Welch. “Britain’s National Health Service now explicitly informs women that their chance of overdiagnosis with mammograms is about three times higher than their chance of avoiding a breast cancer death. The chances of overdiagnosis are surely higher in the U.S., where we look harder for early breast cancer.”
And, despite the harms, older women invited to screening are being entered into a randomised controlled trial – without written or informed consent.
Such overdiagnosis (of these ‘pseudo-cancers’) results in over treatment. And, especially with a diagnosis of Ductal Carcinoma in Situ (DCIS), will not mean less aggressive treatment than if found later. Finding breast cancer ‘early’ – or more correctly when small – can mean becoming a ‘cancer patient’ rather than being cancer-free – or becoming a ‘cancer patient’ earlier than otherwise, with no benefit – only harm.
When Screening is Bad for a Woman’s Health. H Gilbert Welch. Los Angeles Times. July 2015.