Remember the controversy that the United States Preventive Services Task Force (USPSTF) stirred up 3 years ago with its then latest recommendations on screening for breast cancer? Remember the prospective cohort study published in the Annals of Internal Medicine last October in which the authors concluded that annual mammograms increased the risk of false positive interpretations? Remember the retrospective study published earlier this past April in the Annals of Internal Medicine in which the authors concluded that breast cancer was overdiagnosed in 15-25% of women who were screened?
If so, then you might not be so surprised to hear that the Independent UK Panel on Breast Cancer Screening concluded in a review published yesterday in Lancet that every 3rd year screening from 50-70yo decreased breast cancer mortality but also increased overdiagnosis, similar to conclusions from the other side of the pond. In fact, for every 10,000 50yo British women screened for 2 decades, mammography would prevent 43 breast cancer deaths while 129 cases of breast cancer would be overdiagnosed. By overdiagnosis, we conclude that it's unlikely that cancer would've led to that person's demise. In other words, for every death prevented, 3 women were treated who would never have needed treatment and thus needlessly suffered from the side effects of treatment.
Am I anti-mammogram? Of course not! Just like I'm not anti-PSA either. Instead, rather than paint with a broad brush, we need to start wielding a very fine paintbrush and personalize testing & treatment options to the individual. So don't blindly order a mammogram but rather have a conversation with your patient and discuss both the benefits and the potential negative consequences, too.
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