Gerd Gigerenzer explains why patients, the public and doctors, too, do not understand what constitutes evidence for ‘saving lives’ and offers clear tools for informed choice. There is a fact box for mammography screening, with options below – ‘open in new tab’ brings up a larger version of the the fact box for easy reading.
Time to change communication from dodgy persuasion to something straightforward. Gerd Gigerenzer. BMJ 2016;352:h6967
- and in the same issue of the BMJ, Vinay Prasad, Jeanne Lenzer and David H Newman argue that reductions in overall mortality should be the benchmark and call for higher standards of evidence for cancer screening, rather than disease-specific mortality. Disease-specific mortality does not take account of deaths from treatments, overdiagnosis/overtreatment, or other effects, they explain.
‘A systematic review has shown that the public has an inflated sense of the benefits and discounted sense of the harms of mammography screening, the cervical smear test, and PSA screening.’ They say that primary screening studies pay little attention to the harms of screening.
‘Women should be told that to date, with over 600 000 women studied, there is no clear evidence of a reduction in overall mortality with mammography screening.’
In their conclusion they say, ‘We encourage healthcare providers to be frank about the limitations of screening—the harms of screening are certain, but the benefits in overall mortality are not. Declining screening may be a reasonable and prudent choice for many people.’
Currently, there are 12 rapid responses to this article.
Why cancer screening has never been shown to save lives – and what we can do about it.
Vinay Prasad, Jeanne Lenzer, David H Newman. BMJ 2016;352:h6080