Breast screening using mammography is "unjustified", concludes an article published yesterday in the medical magazine The Lancet*. In an argument which would not have disgraced a bunch of clerics debating the number of angels who could stand on the head of a pin, two Danish medics have trashed a decade's worth of research and added yet more weight to the growing grumbling about the money being spent on early screening for breast cancer.
Peter Gotzche and Ole Olden are not alone in their belief that breast screening programmes are a waste of money. Michael Baum, professor of surgery at the Royal Free, has long been a critic of the programme he helped to set up ten years ago. If, on the basis of this article, more influential doctors climb onto this particular bandwagon, women could well see the screening programme dismantled and the funds diverted elsewhere.
The Danish researchers picked holes in the methodology of virtually every piece of research which shows that screening works. They were particularly scathing about both the research and the effects of screening in Sweden where death rates have barely dropped in the 15 years since screening was introduced. Sadly they didn't take that crucial step back and look at the bigger context.
In Sweden, the five year survival rate (which is how success is measured), currently stands at 80% - the best in Europe. Screening may not have improved the rates but, it could be argued, it has held the death rate steady and lengthened lives. Any future improvement will probably rely on better treatments.
Our own particular situation is very different. Five year survival rates in England and Wales are still only at 67%, but even that is a significant improvement since the introduction of screening, while death rates dropped by 14% over the first ten years of the programme. But these are just statistics - to be chewed over by accountants. The personal implications are even more compelling. Last year the programme detected 3,381 cancers smaller than 15mm. That means smaller than you could feel by examining your own breasts in the bath. Each one of those cancers discovered stood a higher chance of successful and less radical treatment than could have been possible by the time even the most conscientious amongst us might have made it to a doctor.
There are still some cancers which do not respond to treatment, however early we catch them, and treatment is rarely cure (many women die of their cancers years later) but screening gives us knowledge and knowledge gives us the power to make demands for better treatments and more targetted screening. Scientists might be more usefully employed looking for those.
• Angela Phillips is the coeditor of The New Our Bodies Ourselves (British Edition), Penguin.
* Getzsche, Peter and Olson, Ole, Is Screening for breast cancer with mammography justifiable? Lancet Vol 355 Jan 8 , 2000.
