Mammography for symptomless women – not so wise?

ABSTRACT

For over 20 years, medical authorities have urged asymptomatic peri/postmenopausal women to undergo frequent mammography. In a recent paper, the authors tested whether early detection reduced the incidence of previously undetected late-stage cancer and saved lives. They compared data from 1976–1978 (pre- mammography) to 2006–2008 US data. Annualized age-adjusted cancer data per 100 000 women ≥ 40 years old showed that early-stage cancer detection cases increased, from 105 to 178 cases of localized disease and from seven to 56 cases of ductal carcinoma in situ; regional invasive late-stage cancer diminished slightly, from 85 to 78 cases; distant late-stage cancer showed no decline, with 17 cases in both 1976–1978 and 2006–2008; breast cancer mortality declined by 20 per 100 000 women, from 71 to 51 cases.

Since mammogram detection produced no decline in late-stage distant cancer presentations (with high mortality rates), and an extremely modest reduction in invasive regional disease (with low mortality rates), improved treatment, not early detection, is the likely engine for the lives saved.

Overdiagnosis – estimated at about 70 000 US women per year – inflicts terror, and triggers biopsies followed by unnecessary medical treatments that are painful, potentially harmful, may impair immune responsiveness and increase the risks for other cancers. Given the availability of annual clinical exams, routine mammography screening should now be seriously questioned.

Key words::

• MAMMOGRAPHY
• SCREENING
• BREAST CANCER
• ASYMPTOMATIC PERI/POSTMENOPAUSAL WOMEN
• OVERDIAGNOSIS
• MORTALITY

Conflict of interest The authors report no conflict of interest. The authors alone are responsible for the content and writing of this paper.

Source of funding Nil.