Dépistage systématique par
mammographie, rapport du 15 décembre 2013
Some 5,400 women contract breast cancer in Switzerland every year, and around 1,400 die of this disease annually. “Systematic mammography screening” is the term used to describe the serial radiological examination of women within the framework of a screening program. Thereby all women in a specific age group are invited to an X-ray examination of their breasts which is not conducted by a doctor. In some Cantons, such screening programs are offered to all women aged from 50 to 69.
In the present report by the Swiss Medical Board, the issue is addressed of whether, by using systematic mammography screening, tumors can be detected at an earlier stage, so that the survival time with good quality of life of the affected women can be prolonged, and, in the final analysis, the mortality rate from breast cancer can be reduced. The potentially negative effects of the screenings (such as excess therapy or psychological stress in the event of false positive examination results) are assessed, as well as the costs-effectiveness ratio.
On the basis of the existing literature, the conclusion can be drawn that systematic mammography screening can contribute to the discovery of tumors at an earlier stage. The mortality rate from breast cancer can be reduced slightly by means of the screening: According to study data from the years 1963 to 1991, of 1,000 women with regular screening, 1 to 2 fewer women die from breast cancer than 1,000 without regular screening. This desirable effect is offset by the undesirable effects: Specifically, with about 100 of 1,000 women with screening, erroneous undesirable effects: Specifically, with about 100 of 1,000 women with screening, erroneous treatments. Furthermore, the costs-effectiveness ratio is very unfavorable.
The findings from the present investigation lead to the following recommendations:
It is not recommended that systematic mammography screening programs be introduced.
A time limit is to be set on existing systematic mammography screening programs.
All forms of mammography screening are to be evaluated with regard to quality.
Likewise, for all forms of mammography screening, a previous thorough medical evaluation and a comprehensible clarification with presentation of the desirable and undesirable effects are recommended.
Despite great strides in prevention and treatment, cancer rates remain stubbornly high and may soon surpass heart disease as the leading cause of death in the United States. Increasingly, we and many other experts believe that an important culprit may be our own medical practices: We are silently irradiating ourselves to death.
The use of medical imaging with high-dose radiation — CT scans in particular — has soared in the last 20 years…
Hilda Bastian is cartoonist and writer at StatisticallyFunny blog
The “get in early!” assumption has an in-built tendency to lead us astray when it comes to detection of diseases and conditions. And even most physicians – just the people we often rely on to inform us – don’t understand enough about the pitfalls that lead us to jump to conclusions about early detection too, well…early.
Those who need it least get the most early detection
Over-diagnosis from detecting people who would never have become ill from the condition detected
The statistical effect that means survival rates “improve” even if no one’s life expectancy increases
Hilda Bastian is Editor etc at PubMed Health, blogger at Scientific American. Commenting on epidemiology with cartoons at Statistically funny.
Is looking hard for things to be wrong a good way to promote health?
According to an extensive U.S. study, mammograms have led to more than one million women being “over-diagnosed” with the disease over the past 30 years. This means the mammograms detected tumours that would never have developed into full-blown disease. It also means that many of these women have undergone unnecessary and invasive drug treatment and radical surgery due to misdiagnoses.
The study also concluded that mammography had little impact on reducing the number of cases of late-stage breast cancer, and had little effect on the rate of death from breast cancer. This contradicts the cancer industry’s claim that “survival rates” for breast cancer are increasing due to early their interventions and detections.
It’s easier to transform people into new patients than it is to treat the truly sick
” Early diagnosis has become one of the most fundamental precepts of modern medicine. It goes something like this: The best way to keep people healthy is to find out if they have (pick one) heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or, of course, cancer — early. And the way to find these conditions early is through screening. ”
Better communication needed in health screening programmes
Screening always sounds good – catch disease early, while it can still be treated – but the reality includes overdiagnosis – picking up “diseases” that were never going to cause any problem – and screening has side effects.
The problem is that doctors and researchers have known about these downsides of screening for decades, but the message hasn’t got through to patients.
Because screening is a mixed bag of benefit and harm no one should impose their own values onto another person…
Ref: ” …the excesses in medical care and how to correct them… , …The evidence is compelling that we in the developed countries (especially the US) are overtesting for disease, overdiagnosing it, and overtreating. Wasteful medical care of milder or nonexistent problems does more harm than good to the individual patient, diverts scarce medical resources away from those who really need them, and is an unsustainable drain on the economy. ”