To the point

To the Point - Guest column

By Cornelia J. Baines 

Since the late 1980s people have argued heatedly about the usefulness of mammography screening, especially in women aged 40 to 49. This unceasing controversy continues. Burgeoning new research in the first decade of 2000 clearly revealed that therapy was outweighing the impact of mammography in terms of mortality reduction. But the defence of screening persists. In September 2012, the Journal of Medical Screening (JMS) issued a supplement reporting that, based on European data, screening benefits were unquestionable. I document the flaws underlying this conclusion, but these flaws are more easily understood when framed by the controversy’s history. So I outline events up to 2000 and then critique the JMS message.

Since 2000, many downsides of screening have been widely reported. Twenty-one hundred (2,100) women aged 40 to 49 must be screened every two years for 11 years to avoid one breast cancer death. Of these, 700 women endure false-positive screens leading to unnecessary diagnostic work-up and anxiety, and ten to 15 will be over-diagnosed and receive unnecessary breast cancer treatment. (Having breast cancer, I am appalled that anyone might undergo unnecessary therapy.)  Importantly, contrary to expectations, screening has not reduced subsequent incidence of advanced cancers, a prerequisite for successful screening.

Sometimes we come across women’s health issues that are simply crying out for a response, be they from the world of research, from popular media, or from the experiences of individual women. At the CWHN we decided to create a space for that response here on our website, and to invite guest commentaries from people with health knowledge and expertise who are willing to speak out and get "To the point" about some of these issues. Watch this space for informed guest columns with a new topic every month. And let us know what you think by writing to us at cwhn@cwhn.ca.

To the Point - Guest column

By Abby Lippman