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2 Critics Demand ‘Honesty’ On Mammography

September 5, 2011
Written by: , Filed in: Breast Imaging, Medical Ethics
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Two Danish researchers have blasted the English National Health Service’s breast cancer screening program, saying that its promotional material exaggerates the benefits of mammography and plays down the risks.

Peter C. Gøtzsche, MD, and Karsten Juhl Jørgensen, MD, make their charges in the current issue of the Journal of the Royal Society of Medicine. Their article carries the provocative title “The Breast Screening Programme and misinforming the public.”

Drs. Gøtzsche and Jørgensen work for The Nordic Cochrane Centre in Copenhagen, Denmark. Dr. Gøtzsche is director, and Dr. Jørgensen is a researcher. The Centre focuses on health care, doing research and reviewing others’ research. It and its parent organization, The Cochrane Collaborative, have in the past expressed skepticism about the benefits of mammography.

Regarding the NHS’s Breast Screening Programme, Drs. Gøtzsche and Jørgensen wrote: “Spokespeople for the Program have stuck to the beliefs about benefit that prevailed 25 years ago and continue to question the issue of over-diagnosis.”

The researchers’ conclusion:

Women therefore cannot make an informed choice whether to participate in screening based on the information the Program provides. This must be changed.

The authors make two main contentions:

  • That the program exaggerates the benefits of screening. The program estimates that regular screening over a 10-year period prevents one breast cancer death per 400 women. The authors say that figure “is wrong by a factor of five,” contending that one death per 2,000 women is more accurate.
  • That the program never mentions the significant dangers of overdiagnosis—findings of cancers that will not cause symptoms during the patient’s lifetime or premature death.

One could undoubtedly level those same accusations against some breast cancer screening programs in the United States, and other countries as well.

Dr. Gøtzsche has made a career of being a provocateur, criticizing both the methods of individual researchers and such general practices as medical ghostwriting. Some find him annoying. But he still may have a point. Overselling benefits and minimizing risks does a disservice to patients. And, in the United States at least, it can also lead to malpractice suits.

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Related seminar: Breast Imaging and Digital Mammography

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