Breast screening: an obsessive compulsive disorder

Yunus A. Luqmani

Population-based mammographic screening, founded on the premise that 'early is better than late,' has been adopted in several countries but has been the subject of controversy since its inception. Findings and interpretation of clinical trials data vary considerably, with disagreement on the outcome and value of such a procedure. In recent years, misgivings are being voiced from many quarters, not just about the benefits but about the potential harms of mass screening. The many are being screened for the benefit of the few. Even this might be acceptable,  but the realization that a significant proportion of women with screen detected cancers that will potentially not cause them harm, and who are very likely receiving unnecessary treatment, has sparked further concern. Many are calling for re-assessment of the age of commencement and periodicity if not complete cessation of indiscriminate screening. An aspect of great concern is that screening is being vigorously advocated by many healthcare workers, the media, and lay persons alike without proper awareness or appreciation of the consequences. Although some National Health Department leaflets are now presenting a truer picture, there is still a distinct lack of transparency to allow women to distinguish perception from reality and to make informed choices. How many would elect to be screened if they knew that for every one woman who is notionally saved by early detection, anywhere from 2 to 10 otherwise healthy women are being turned into breast cancer patients?