Swiss Medical Board:
Abolish routine breast screening
It’s happened again, an expert review of mammography screening has revealed the ugly truth – as a public health program, routine screening produces more harms than benefits, and therefore cannot be justified. Writing as members of the Swiss Medical Board, mandated to review routine mammography screening, their article titled “Abolishing Mammography Screening Programs? A View from the Swiss Medical Board”, speaks out about their findings.

Nikola Biller-Andorno, M.D., Ph.D., and Peter Jüni, M.D. offer their view independently of the rest of the panel, nevertheless the prognosis from the review is damning.

They reduce their findings to three central points:

1. The current debate about routine breast screening is based on a rehash of the same predominantly outdated trials starting more than 50 years ago and totally disregarding “modern breast-cancer treatment, which has dramatically improved the prognosis of women with breast cancer.” Biller-Andorno and Jüni ask whether the modest benefits in terms of mortalities between 1963 and 1991 would be detected in a trial conducted today.

2. They were struck at how a relatively small reduction in breast-cancer mortality associated with mammography (20%), comes at the very high price of 22% over-diagnosis. This means that nearly a quarter of positive detections by mammography were treated unnecessarily, by needless surgical interventions, radiotherapy, chemotherapy, or some combination thereof.

3. They ask: “How can women make an informed decision if they overestimate the benefit of mammography so grossly?” They were struck by the large discrepancy between women’s perceptions of the benefits of mammography screening and the real benefits to be expected. In a survey conducted in the US(a), 71.5% of women said they believed that mammography reduced the risk of breast-cancer deaths by at least 50% – while in reality the reduction in breast-cancer mortality associated with mammography is approximately 20%.

The Swiss Medical Board’s report was published in February 2014 (www.medical-board.ch). It acknowledges that while routine mammography screening might prevent about 1 death attributed to breast cancer for every 1000 women screened, false positive test results and the risk of over-diagnosis represents a significant harm in contrast with such a modest benefit.

Recommendation
The Swiss Medical Board recommenders that no new routine mammography screening programs should be introduced and that existing programs be phased out in time. In addition, clear and balanced information should be provided to women to restore the balance of their perceptions regarding the benefits and harms of mammography screening.

(a) Domenighetti G, D’Avanzo B, Egger M, et al. Women’s perception of the benefits of mammography screening: population-based survey in four countries. Int J Epidemiol 2003;32:816-821