Breast Cancer Screening Comes Full Circle

Extract

During the mid-1990s, I was invited to address the local chapter of the American Cancer Society in Miami, Florida, to talk about the British approach to mammographic screening. During my presentation, I described the tough issues of balancing the benefits for the few versus the harms for the many, and I suggested that maybe screening does not benefit the premenopausal woman at all. Despite my role in establishing the National Screening Programme when I was Chief of Surgery at King's College London in 1988, my comments were not well received, and, as the audience stormed out on me in a paroxysm of pique, I learned a painful lesson that day that some topics, particularly breast cancer screening, do not lend themselves to polite and rational scientific debate.

However, I believe that a scientific debate is highly warranted because screening for any disease is notorious for the artifacts it throws up that make interpretations of apparent benefit extremely difficult. In particular, there are at least three screening artifacts or biases applying to breast cancer screening by mammography.