American doctors who routinely give mammograms to women under 50 are needlessly exposing them to radiation and inaccurate diagnoses, charge two leading British cancer specialists.
In a special feature in the British Medical Journal (4 December 1993), Ismail Jatoi and Michael Baum from London's Royal Marsden Hospital label doctors following the American Cancer Society's suggestions for mammogram screening of women under 50 "negligent" if they don't warn patients of the potential dangers.
In America, the ACS advocates that all women from the age of 40 be screened, whereas in Europe, screening is not recommended for women under 50.
"Advocating mammography for younger women without obtaining proper informed consent, including the potential for harm as well as for benefit, must be considered negligent," say Jatoi and Baum.
They argue that this approach is flawed because in many cases, earlier diagnosis doesn't improve prognosis; women must live with the knowledge that they have cancer for longer than necessary.
This type of aggressive screening also results in overdiagnosis detection and treatment of cancers which otherwise would have remained dormant, doing no harm.
There is also the problem of radiation exposure which itself can cause cancer and of turning up "false positives", in which women are wrongly told they have cancer.
Baum and Jatoi point out that both Europe and America came to their vastly different approaches after reviewing exactly the same data, which show no benefit from screening women earlier.
In their view, the Americans opted for earlier screening even though the literature doesn't support it because they tend to favour aggressive medical intervention and reject conclusions that don't fit in with what they perceive as an obvious benefit.