Lessons learned in the mammography debate

Earlier this year, the Swiss Medical Board fanned the flames of the screening mammography debate when it argued that new systemic mammography screening programs should not be introduced and that existing programs should be halted.

As with the U.S. Preventive Services Task Force’s 2009 recommendations against universal breast cancer screening in women aged 40 to 49, the Swiss Medical Board’s assessment sparked a firestorm of discussion. Cancer associations in both Switzerland and in the U.S. rejected the report.

While the call to totally abandon systemic screening mammography programs went too far, the Swiss Medical Board’s assessment did offer a few valid lessons that breast imaging specialists should take to heart. The lessons were outlined by a pair of Swiss physicians who published an editorial this week in JAMA Internal Medicine.

One of the major issues raised by the Swiss Medical Board report was that most evidence supporting the benefits of mammography comes from studies that are more than 30 years old. Much has changed in terms of both scanning technology and treatment effectiveness, wrote editorialists Arnaud Chiolero, MD, PhD, of the Institute of Social and Preventive Medicine, Lausanne University Hospital, and Nicolas Rodondi, MD, MAS, of the Department of General Internal Medicine, Bern University Hospital. Newer studies should be used to update the evidence, they argued, and these new studies should look at outcomes beyond mortality, such as mastectomy rates and disease-free survival.

Another lesson Chiolero and Rodondi took from the Swiss Medical Board report that all imaging specialists should internalize is that communication and transparency with patients is key. Mammography is not a silver bullet, and its benefits have been oversold to the public. Women need to be made aware of both the risk for missed cancers—especially in those with dense breast tissue—as well as the potential for false-positives.

“The fact of the matter is that some women benefit from screening mammography but others do not; some women are harmed but others are not,” wrote Chiolero and Rodondi. “Health professionals and organizations providing mammography screening should provide women with information that is complete but easy to understand. They should avoid paternalistic persuasion to maximize the uptake of screening.”

The Swiss Medical Board overreacted in calling for systemic screening programs to be dismantled, but by listening to the legitimate concerns raised by its report, care for women all over the world could be improved.

-Evan Godt
Editor – Health Imaging