Promoting Screening Mammography: Insight or Uptake?

Abstract

The US Preventive Services Task Force has emphasized individualized decision-making regarding participation in screening mammography for women ages 40 to 49. Positive public opinion regarding screening mammography is understandable given that screening advocates have heavily promoted the slogan "early detection saves lives" while ignoring screening harms. The goal of mammography screening advocates is to increase screening participation or uptake. The purpose of this paper is to promote physician and patient insight by presenting the age-related benefit and harms of screening.

Population-based service mammography screening: the Icelandic experience

“…Despite a 14% mortality reduction in the 40-49 age group, however, the Task Force recommended risk evaluation due to a risk of false diagnosis of suspected benign changes at that age. 5,6,11 Some researchers agree with these reports, [12][13][14][15][16] but others have protested these findings. [17][18][19][20][21][22][23] Critics of the USPSTF report have pointed out the poor quality of some of the included data and the fact that 80% of breast cancers occur in women with no family history of the disease.…”

This Issue: International Issues, Infectious Diseases, Medical Liability, and Medical Home Ideas

“…Mammograms are widely believed to prevent breast cancer and to reduce strongly its subsequent mortality. However, evidenced-based findings do not support the strength of these beliefs, 6 yet these same beliefs probably lead to a number of malpractice suits, and possibly even to some unwarranted payouts. Keen 6 provides data to put into perspective the utility of screening mammography as a diagnostic tool to prevent breast cancer death, and he argues that the decision of some women to avoid mammograms should be respected.…”

“…4 Check out the research letter about what is known and preconceived notions about mercury dental fillings for those patients who are bringing you questions, 5 and also take a look at the analysis of the mammogram controversy. 6 We also have a special commentary and editorial about care for veterans in civilian primary care.…”

Four Principles to Consider Before Advising Women on Screening Mammography

“… 1 The simplistic but effective mantra that “early detection saves lives” is one cause of the general enthusiasm for cancer screening. 2 In the United States (U.S.), a double standard exists: women are encouraged to participate in screening mammography, while men are advised to make informed decisions regarding prostate screening, although the fundamental issues to consider are very similar. 3–5 While professional society screening guidelines generally promote breast screening, they may be influenced by intellectual and financial conflicts of interest and generally have a poor evidence base compared with, for example, those from the U.S. Preventive Services Task Force.…”