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A new study adds to the debate about how the benefits and harms of screening mammography are presented to the public and provides new estimates of the absolute numbers of breast cancer deaths prevented by the screening. The authors argue that the public is not currently presented with a balanced view of the screening, with potential benefits overemphasized and potential harms rarely discussed.

The study was published April 2 in the open-access online journal BMC Medical Informatics and Decision-Making.

Repeated screening mammography starting at age 50 saves about 1.8 lives over 15 years for every 1000 women screened, according the study authors.

They calculated that the absolute death risk from breast cancer without any screening is about 1% over those 15 years. "This means the survival percentage among women aged 50 to 60 who are not screened is 99%," said lead author John D. Keen, MD, senior attending radiologist at the John H. Stroger Hospital of Cook County, in Chicago, Illinois.

These statistical facts about mammography are in sharp contrast with what is most publicized about this screening, which is "mammography saves lives," suggested Dr. Keen.

"From a consumer perspective, the screening-mammography discussion in the United States is rather paternalistic and 1-sided," said Dr. Keen in an interview with Medscape Oncology.

What's needed is a balanced presentation of the facts to patients, which should include mention of the absolute benefits associated with screening and a discussion of potential harms, such as false positives, anxiety, unnecessary biopsies, and overdiagnosis, emphasized Dr. Keen. "This is not occurring now," he added.

However, a critic of the study says that its statistical methods are questionable and its findings debatable. Furthermore, the paper "labors an obvious point" about preventive medicine, says the critic.

"One has to apply an intervention to large numbers of healthy subjects in order to benefit the few who are unlucky enough to develop the disease," writes Stephen W. Duffy, MD, from the Cancer Research Center, in London, the United Kingdom, in an editorial that accompanies the study.

Dr. Keen's response to that criticism was that the "public has a right to know what the statistics are regarding mammography screening so that individuals can make informed decisions about participating."

Source: Medscape Today