Perhaps and perhaps not? I belive it is alot more complicated than the statistics you refer to. The screening program is far from good enough how ever the avereness of the threat needs to remain active. The caregiver is required to have something to offer and that something has to add up to the image of what we expect. Radiology although far less sensitive then MRI is far cheaper and a thorough self examination is perhaps just as good in some cases. (excluding very larg breasts that are difficult). Still, people tend to rely more on hard core data and technology. Something new has to come along and in the mean time we just have a system of followups and the awereness screening programs do offer and that has to count for something. I would be careful to attack the system without an alternative unless the goal is to simpely ruin the system. And to justify that I do not thank you have good enough evidense to back it up. Keep up the good work.

Being a woman and having having been there and done that (too many times) have to inform you that we have known this for many many years.

Lots has been published on this topic but not in medical journals.

Its a painful procedure and indeed may increase the risk because of bruising and damage of benign material. I have stopped being tested in this manner many years ago. It is still be offered by my country's health system as a safe and free screening possibility.

My very experienced MammaCare surgeon informed me that self examination is still the best. We have various possibilities such as thermal imaging and ultrasonor testing... and they are, after selfexamination (or regular checks by the healthprofessional), the best and safest for now. On the topic of MRi's, they are not as available as one would like. They have to be specific for the breast and I have been informed that not many hospitals have them (even in Northern Europe) yet.

I applaud everyone that is game enough to attach the system (regarding this issue), because The System is not always right is it.

Hell yes. So glad mum had suggested we get regular mammograms and that allowed me to ,go annually from age 40 or was it 45? I was diagnosed with an aggressive stage 3 triple positive cancer month after 50th birthday and year after she had died from secondaries. Would and have recommended free Breast screen mammogram to friends & colleagues with several going for their first one in the 8 months I was having my chemo and radiation treatment before returning to work while on the year of Herceptin.

While there may be a few false positives, further scans biopsy etc confirms the diagnosis. There are many more false negatives with the far more expensive slower ultrasound or mri type technologies.

While self examination plays a part, it is difficult if you have large variable breasts of the pre or peri menopausal woman. Even doctors dont always feel the lumps while small if they even do that when one goes for an annual checkup and pap smear at ones busy GP or medical practice.

Hi Carol,

I understand your reaction very well. It is good that both sides of the story are told.

I am truly glad for you that you were on time.

I started having yearly mammograms when I was 30 yrs old. Had become a little paranoid from treating many young women with lymphoedema after breast surgery and having a mum that had been diagnosed with breast cancer (66)at the time. I was well endowed and difficult to palpate.

The mammograms not only hurt but badly bruised me every time.

There is no one really good test.

This leaves women living in countries where mammograms are available (and often free) with a dilemma.

Breast cancer is the most common malignant tumour in women in the UK, with over 40 000 diagnosed annually, over 80% in women over the age of 50. Screening aims to reduce mortality by detecting the disease at an earlier stage, before it has spread beyond the breast. Mammography can significantly reduce mortality from breast cancer, with the benefit greatest in women aged 55–70 years.

Imaging is important not only in the detection and diagnosis of breast disease but also in guiding needle biopsies. Wide use of mammography for screening has resulted in the discovery of increasingly large numbers of small lesions that are impalpable. Percutaneous image-guided biopsy is used for the diagnosis of these lesions, thus avoiding unnecessary open surgical biopsies. Even for clinically palpable abnormalities, image-guided biopsy can improve the diagnostic accuracy. Fine needle aspiration (FNA) was the first method of biopsy employed for breast diagnosis, with samples obtained for cytological assessment. In many centres FNA has been largely superseded by core needle biopsy, allowing tissue to be obtained for histological evaluation. Vacuum-assisted mammotomy (VAM) enables the sampling of larger areas of tissue, further improving diagnostic accuracy.

Breast cancer is the most common malignant tumour in women in the UK, with over 40 000 diagnosed annually, over 80% in women over the age of 50. Screening aims to reduce mortality by detecting the disease at an earlier stage, before it has spread beyond the breast. Mammography can significantly reduce mortality from breast cancer, with the benefit greatest in women aged 55–70 years.

Imaging is important not only in the detection and diagnosis of breast disease but also in guiding needle biopsies. Wide use of mammography for screening has resulted in the discovery of increasingly large numbers of small lesions that are impalpable. Percutaneous image-guided biopsy is used for the diagnosis of these lesions, thus avoiding unnecessary open surgical biopsies. Even for clinically palpable abnormalities, image-guided biopsy can improve the diagnostic accuracy. Fine needle aspiration (FNA) was the first method of biopsy employed for breast diagnosis, with samples obtained for cytological assessment. In many centres FNA has been largely superseded by core needle biopsy, allowing tissue to be obtained for histological evaluation. Vacuum-assisted mammotomy (VAM) enables the sampling of larger areas of tissue, further improving diagnostic accuracy.

Screening mammography has been proven through randomized controlled trials (RCTs) to reduce breast cancer deaths in women who are screened regularly using high-quality mammography. A recent update of the Swedish 2-country trial (with 29 years of follow-up), for example, showed a statistically significant 31% breast cancer mortality reduction among women ages 40-74 invited to screening mammography compared to a control group not invited to screening mammography. (Tabar L, et al, Radiology 2011; 260: 658-663, and references therein) The study also found that the number of women needed to undergo screening for 7 years to prevent one breast cancer death was 414-519, quite a different result that those cited by Peter Gotzsche. Bear in mind also that because RCTs use breast cancer mortality as an endpoint, the screening mammography performed in them (in the 2-county trial, from 1977-85), while of high quality at the time (at least in Sweden), was not nearly the quality of screening mammography done today. There are many other more recent population studies and case-controlled studies in Sweden, the Netherlands, Canada, and Italy that show that for women who actually get regular screening (rather than just an invitation to screening), the mortality reduction far greater than 31% (up to 76%) among women who get screening compared to a similar group of women who do not.

It is also important to recognize that the first medical imaging that occurs in a woman over 30 who shows up with a suspicious physical finding (a lump, nipple discharge, etc) is diagnostic mammography, basically the same 2-view exam done in screening, with the addition of possible extra views, and in some cases ultrasound, of the suspicious area.

The point of screening mammography is to find breast cancer in an earlier and more treatable stage than is possible by waiting until the breast cancer is physically apparent (even with high-quality clinical breast exam or breast self-exam). There is clear evidence that high-quality screening mammography reduces the stage and severity of treatment needed for women who have breast cancer (see, for example, Malmgren JA et al, Radiology 2012; 262: 797-806 and Foca F, et al., Cancer 2013; 119: 2022-2028). U.S. SEER breast cancer statistics (available on the web at seer.cancer.gov) show that women with a localized breast cancer have a 98.6% 5-year survival rate, while women with a distant breast cancer (metastases) have a 24.3% 5-year survival rate. It's basically the difference between a woman being told that her breast cancer is curable and being told that she will live fighting breast cancer until she dies from it in the not-too-distant future.

The lead time for mammography (the time between a lesion being mammographically detectable and physically detectable) is about 18 months in pre-menopausal women and about 3 years in post-menopausal women. Screening only works if the frequency of screening is shorter than the lead time for the exam. That's why screening is recommended annually for women ages 40 and over by organizations such as the American Cancer Society and American College of Radiology.

A summary of both sides of the screening mammography debate, along with additional references, can be found in Javitt MC et al, Medical Physics 2012; 39: 4047--4050. For detailed breast cancer screening recommendations in the U.S. and additional supporting citations, see Lee CH et al, J. Am. Coll. Radiol. 2010; 7: 18-27, which is one of my posted publications on ResearchGate.

The biggest controversy is that there is no overall mortality reduction in female population even after two decades of breast cancer screening. Yes, there is breast cancer-specific mortality reduction, but not overall mortality for the same patients. Why? Are we talking about mortality type replacement and not improved at all?

Hi Edward, you have correctly used the word high quality mammography. I am not so sure that this will be the cases everywhere. The machines differ, pressure differs and even in Holland where I was always screened difference machines were used. And I am not so sure that in Holland we have high quality machines in place everywhere.

Maybe in Sweden, in in the rest of the world?

A very large randomized screening trail (89 835 women, aged 40-59) with 25 yrs follow up has been published in the BMJ.

Conclusions are:that 'Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available. Overall, 22% (106/484) of screen detected invasive breast cancers were over-diagnosed, representing one over-diagnosed breast cancer for every 424 women who received mammography screening in the trial.'

Open access article can be found here: http://www.bmj.com/content/348/bmj.g366