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Experts Explain Anti-mammography Suggestions

April 22, 2014
Written by: , Filed in: Breast Imaging, Medical Ethics, Practice Management
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Why did the Swiss Medical Board recommend that no new mammography screening programs be introduced and that existing programs be time-limited? Two members of the expert panel that advised the board explained their reasoning in an article published online last week in The New England Journal of Medicine (NEJM).

They admit that the report, dated December 15, 2013, and made public on February 2 of this year, “caused an uproar.” (You can read the report here—if you read German. For a summary in English, click here.) But they’re unrepentant:

One of the main arguments used against it was that it contradicted the global consensus of leading experts in the field—a criticism that made us appreciate our unprejudiced perspective resulting from our lack of exposure to past consensus-building efforts by specialists in breast-cancer screening.

Yikes. That seems to stop just short of a very nasty accusation.

Nikola Biller-Andorno, MD, PhD, and Peter Jüni, MD, wrote the NEJM article. Dr. Biller-Andorno is professor and director of the Institute of Biomedical Ethics at the University of Zurich. Dr. Jüni is director of the Institute of Social and Preventive Medicine at the University of Bern and of CTU Bern, the university hospital’s clinical trials unit. Dr. Biller-Andorno is still a member of the medical board’s expert panel; Dr. Jüni left the panel on August 30, 2013.

Their argument is familiar: that the harms of overdiagnosis and overtreatment outweigh the benefits of mammography screening. “For every breast-cancer death prevented in U.S. women over a 10-year course of annual screening beginning at 50 years of age,” the NEJM article says, “590 to 670 women are likely to have a false positive mammogram with repeat examination; 70 to 100, an unnecessary biopsy; and 3 to 14, an overdiagnosed breast cancer that would never have become clinically apparent.”

Despite all the Sturm und Drang, the article acknowledges that the inflammatory report may not change anything about mammography screening in Switzerland: “The Swiss Medical Board is nongovernmental, and its recommendations are not legally binding. Therefore, it is unclear whether the report will have any effect on the policies in our country.”

Related CME seminar (up to 8.25 AMA PRA Category 1 credits™): Breast Biopsy – Ultrasound, Stereotaxis & MRI Guidance

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One Response to “Experts Explain Anti-mammography Suggestions”

  1. Mammogram Screening | Benefits and Risks of Mammography on April 26th, 2014 at 8:03 pm

    […] Experts Explain Anti-mammography Suggestions – Radiology Daily […]