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Swiss views

April 22, 2014

Abolish breast cancer screening

The Swiss Medical Board, an independent group set up by their Ministry of Health to evaluate health technologies, has just reported on mammography screening for breast cancer – full report here, summary in the New Engl J Med (here), or for those without access Abolishing screening.Swiss.

The authors concluded that screening did more harm than good, and that women were being misled. They recommended that no new programmes be introduced, and that time limits be placed on existing ones.  Their reasoning was simple.

1. The evidence of benefit comes from rather old trials, and it’s not clear how relevant these are to modern practice. If mammography has improved, the benefit of screening today may be larger than the trials showed, but insofar as conventional treatments of breast cancer have improved, the benefit of screening will be smaller.

2. Any benefit comes at the expense of much harm.

3. The ratio of benefit to harm is hugely overestimated by most women. The authors demonstrated this discrepancy between perception and reality in a simple graphic.

breast screening graphic

Click on it. It’s worth a thousand words.

Jim Thornton

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2 Comments leave one →
  1. April 23, 2014 3:20 pm

    i am currently working (though I am not sure how long I can stand it) in Ethiopia and was invited to speak to a group ‘health professionals’ about screening for cervical ca. No point screen for pre-malignant disease.. They also asked me to talk about breast cancer screening using self examination, also probably no point and potentially very harmful. Africa is desperate to follow the developed world (sorry high income in our politically correct times) and i was trying to persuade them that given that the only option here is fairly mutilating surgery not to go down this past. A voice in the wilderness, and there is a lot of it here.
    Jeremy

  2. April 23, 2014 9:49 pm

    The harms of rich country screening aren’t just the direct harms done in the rich country, nor the fact that once started it’s almost impossible to stop because of vested interests, but also the harms of implementing it in poor countries where, even if it did some good, there are much cheaper ways to get the same health benefit. Sad.

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