Is it the beginning of the end for mammography, the screening technology for breast cancer? The Swiss could be the first to drop it after independent research revealed that the risks outweighed any benefits-and that earlier research, which had provided the evidence to launch national screening programmes in most Western nations, had been falsified.
Researchers from the Swiss Medical Board, an independent health research group, first reported on mammography's shortcomings last February, and one Swiss canton, Uri, is now reconsidering a move to introduce it for routine screening.
Others may follow, and two of the board's researchers have spoken out this week because they say it is ethical to do so. "It is easy to promote mammography screening if the majority of women believe that it prevents or reduces the risk of getting breast cancer and saves many lives through early detection of aggressive tumours. We would be in favour of mammography screening if these beliefs were valid. Unfortunately, they are not, and we believe that women need to be told so. From an ethical perspective, a public health programme that does not clearly produce more benefits than harms is hard to justify. Providing clear, unbiased information, promoting appropriate care and preventing overdiagnosis and overtreatment would be a better choice," say Nikola Biller-Andorno and Peter Juni this week.
In their earlier report, the researchers discovered that nearly 22 per cent of 'cancers' that mammography was detecting were false (false-positives). Despite the false reading, many of the women went through arduous cancer treatment, including chemotherapy and even mastectomies, or breast removal.
Early research, including a 50-year-old paper, suggested that screening would save 80 lives per 1,000 women screened. However, the Swiss research found that just one life would be saved by mammography.
(Source: New England Journal of Medicine, 2014; doi: 10.1056/NEJMp1401875)