What Doctors Should be Telling You about Breast Cancer Screening

Some doctors are choosing to ignore the latest research findings on breast cancer screening.  Despite evidence that demonstrates how breast cancer screening may be doing more harm than good, women are still faced with ‘pink’ messaging and propaganda that promotes screening and ignores or downplays the harms.

When new medical research was published in the past, only physicians and academics had easy access to the findings.  The public wouldn’t hear about the new research until much later, if at all.  The Internet has changed that, and these days many women may be more aware of the latest research than their doctors appear to be.  When a new research study is published we can find ways to access the information, and sometimes the new research findings are splashed all over mainstream media.

For example, CTV news reported a study in 2012 which found that mammograms lead to overdiagnosis but have little impact on deaths.  More recently, a New York Times article presented a vast Canadian study which found that breast cancer death rates were the same in women who had undergone mammography and those who had not.

The media’s offerings of research findings and the ease of access to information via the Internet makes it all the more baffling when some doctors continue to practice without acknowledging the latest research evidence.

Fortunately, more women are doing their own research and are making their own informed decisions about screening.  However, because there is a great deal of propaganda and/or misinformation on the Internet, it can often be difficult to know what information is credible, and what information is not.

What follows is a compilation of the most well-researched information regarding breast cancer screening (Special thank you to Elizabeth of Australia and other contributors to this blog for providing the references, inspiration, and information for this post):

  • Mammography leaflet written by Peter Gotzsche, et al.   The leaflet presents information about both the potential benefits and harms of screening, based on the best scientific evidence available (i.e. randomized trials of breast cancer screening).    Excerpt from the leaflet:  Screening produces patients with breast cancer from among healthy women who would never have developed symptoms of breast cancer.  Treatment of these healthy women increases their risk of dying, e.g. from heart disease and cancer.  It therefore no longer seems beneficial to attend for breast cancer screening. http://www.cochrane.dk/screening/mammography-leaflet.pdf   Peter Gotzsche is a professor, chief physician, and director of the Nordic Cochrane Center, Rigshospitalet, Copenhagen, Denmark. 
  • The Nordic Cochrane Center summary on breast cancer screening: http://www.cochrane.dk/screening/index-en.htm

A speech by Peter Gotzsche titled “Time to Stop Mammography Screening” presented at the Evidence Live conference in Oxford in 2013:

  • Article in the New England Journal of Medicine titled Effect of Three Decades of Screening Mammography on Breast Cancer Incidence by Archie Bleyer, M.D., and H. Gilbert Welch, M.D., M.P.H.: http://www.nejm.org/doi/full/10.1056/NEJMoa1206809
  • Research article in BMJ titled Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial: http://www.bmj.com/content/348/bmj.g366

Video by Professor Michael Baum titled Breast Screening: Some inconvenient truths

To conclude, a trailer from the film titled The Promise: truth about the breast screening program

273 comments

  1. “I asked my surgeon at the London hospital what he thought. He answered that in my case we could not go back in time but that screening helped save lives”.
    What do they actually count as a life saved? They throw around large numbers but given lobular carcinoma and DCIS usually go nowhere, can we include these discoveries and “treatments” as a life saved? Sounds a bit too convenient to me…

    We know other breast cancers may not progress either and we know the most aggressive cancers will take lives regardless of screening.
    So how can we reasonably say screening saves 3500 or 8000 lives per annum…

    It’s helpful to throw around large numbers but I don’t buy it…we know most of the decline in breast cancer mortality is down to better treatments, not screening.
    The initial surge in breast cancer diagnosis is a feature of screening, the same applies to thyroid, prostate and some other cancers. The Japanese tried thyroid cancer screening but it was soon apparent that the huge increase in the diagnosis and treatment of thyroid cancer was more to do with screening, than actual cancer that would take a life. (or threaten to)

    I assume this woman would have gone down as a life saved if she’d had part of her breast removed and perhaps, she’s also counted after the radiotherapy…after all, lobular carcinoma “sounds” like cancer. It’s part of the reason they’re thinking of changing the names of these conditions, neither is cancer and is unlikely to ever be cancerous – you could argue many cells in our body are pre-cancerous, especially after a certain age. Some women hear the word carcinoma and would bolt for the operating theatre…cancer!
    The specialist believes screening saves lives, but he’s not having a breast removed – the implications of screening are so severe it can only be the woman who makes the decision, to screen or not. It amazes me that despite the uncertainty and potential for serious harm or even death, they still almost flippantly recommend screening like it’s a no-brainer.
    So to extend screening, against the evidence, to include younger (under 50) and older women (over 70)…well, I fear that will simply worry and harm more women….that’s certainly what the evidence tells us.

  2. Margaret McCartney has been on the case for years about this:
    https://www.bmj.com/content/349/bmj.g5105

    Nobody seems to have approved it but it’s all “going ahead” anyway. By now it’s probably been rolled out across the UK – I’ve not been able to find out for sure.
    This article from the Telegraph just shows what the problems are: normally this lady would not have got her first mammo summons until about age 52, 5 years after this “trial” one at age 47. That’s another 5 years of not living a life of hell in and out of hospital under the shadow of a cancer diagnosis, and her daughters would have been able to finish their schooling without the worry of losing their mum. But what are these trifles to the screening evangelists who have convinced themselves they are saving us from ourselves?

  3. I had lunch with a friend yesterday, she’s been sick with worry to the point of vomiting after a mammogram call-back – she’s been referred to a larger centre, they’ll do another mammogram or two, an ultrasound and, if necessary, biopsies.
    Thankfully, it’s not a long wait but it ruined the Easter break for her, she chose to send her family down to their weekender, she stayed here in Melbourne.
    She knows I don’t have CBEs or mammograms, she respects my decision but she’d be afraid to say no to screening, if she got breast cancer she’d always wonder if the mammogram would have picked it up earlier or saved her life. I don’t judge women who opt for screening, we’re all different, but even when the evidence against mammograms make sense to some women, they still choose to have screening – it sounds to be like the motivation is a fear of breast cancer and wanting to do everything to prevent that happening or at least “catching it early”.
    My friend accepts the NCI report, but while breast screening is recommended, while her GP recommends it, she’ll keep having breast screening.
    The insidious thing is, even if it’s DCIS or a cancer unlikely to take your life, doctors will usually say, “better to be safe than sorry” or “we don’t know what will progress so have to treat everyone”…

    Some women do find screening is far from a no brainer, when they’re presented with treatments for DCIS, do some research and find it’s not really cancer at all. I read an account recently by an American women who was facing a mastectomy for DCIS, she did some reading and decided to stop the surgery and get a second and third opinion.
    Of course, many doctors will side with caution, especially American doctors worried about legal liability. At the very least though, they should opt for conservative measures or watchful waiting rather than rush the woman into surgery.
    I felt for her, she’s clearly terrified, can only hope she gets the all clear next week.
    Funny thing is…she asked me if I was afraid that I might have cancer and not know it…I told her many of us have cancer after age 50, I only wanted to know about life threatening cancers.
    We now know there are tick-tick going-nowhere cancers and life threatening ones, screening exposes us to the risk of treating the tick-tick cancers, and these treatments are far from benign.
    Also, the life-threatening cancers tend to take our lives, with or without screening – it’s Dr Welch’s analogy, containing the turtles (DCIS etc.) and the birds.(life threatening cancers)

    Q: Are you more afraid of breast cancer because you don’t have screening?
    I’d be afraid having mammograms, knowing what I know…

    If I noticed a lump or a change, I wouldn’t let the GP refer me for a mammogram either, it amazes me that’s so often the next step – I wouldn’t be happy to crush a breast lump – an ultrasound is a better first step.
    With older women now having mammograms, those aged 71-74, I think we’ll see a lot more women siting waiting for their work ups – worried sick too.

  4. https://www.smh.com.au/national/samantha-armytage-s-advice-on-mammograms-was-misguided-20180223-p4z1h9.html

    Great that Alexandra Barrett addressed the advice Samantha Armytage gave to viewers, to perhaps, start having mammograms at age 40. This has happened before, female hosts of morning television having an on-air mammogram – then the well meaning but misguided/inappropriate advice. Armytage ended up having a false positive…shame she didn’t spend some time looking at the research. I wish they’d drop this stunt, but I’m sure Breast Screen loves the publicity.

  5. UK ladies. BBC news. Thousands of women not “invited ” for their final breast screening due to computer glitch. It’s “horrifying in a programme designed to keep women safe…”

    • Yep. Let’s not mention the women who have their health ruined and their lives cut short due to overtreatment, eh?

    • How strange that this is all happening after the Irish cervical screening programme went into meltdown last week over sudden discoveries that the test isn’t accurate. Well I never!

      https://www.bbc.co.uk/news/amp/world-europe-43961552?__twitter_impression=true

      The director resigned and there are calls for further resignations. I saw one person say that if the government is going to be sued for every false negative, they will have to shut the screening programme down. Just the situation the UK was in during the 1990’s. No, they’ll go down the same road the UK did – say some poor cytopathologist made a mistake and has now been sacked. Cough up some damages like a couple of million and the programme will run as normal, completely blameless of any errors.

  6. It’s all over the news. It’s a story cooked up. Any woman aged 68 would be having the last one anyway, and it clearly states in the leaflet that you can ask for one after this time. Such a dreadful load of hype…

  7. It’s all kicking off here in the UK over the breast screening scandal. For those not in the UK and if you’ve not heard the story so far: a trial called AgeX to extend the screening programme from age 70 to 73 was started in 2009. It seems 400,000 were removed from our screening prog’s last and final letter as it was not their last screen but never got a letter at all, so didn’t get a last screen. Some of these women in their 70s are now saying it may be shortening the lives, and the news is reporting that maybe 200 may have already died as a result of missing that last screen…
    All the women in the trial are being sent a catch up letter but a group of doctors have written a public letter to get this stopped.

    http://www.bbc.co.uk/news/health-44016206

    • https://www.theguardian.com/society/2018/may/03/jeremy-hunts-rhetoric-over-breast-cancer-screening-looks-overheated

      Chas there seems to be a war on between the statisticians about breast screening in the UK at the moment. The above article quotes Richard Peto denying there was a problem at all. They are all arguing with one another. Sasieni has been paid by Jo’s Tosh to do research for them which enables them to come up with some of their “evidence-based” sensational stats (often taken completely out of context). Peto wrote the famous article from 2004 with the title about how the NHS cervical screening programme has saved Britain from a cervical cancer epidemic. It clearly states about halfway in that it is all pure conjecture, but it was the “research” which enabled the screening programme to keep operating even if flouting the Data Protection Act laws.
      Why are academics who were previously feeding the sensationalist media with how our programmes were world class, now saying they are rubbish? I don’t know if they are cooking up an excuse to launch an enquiry which may ultimately shut down the breast screening programme, or completely redesign it, targeting only specific groups? It’s entertaining watching their sacred cows fall on their knees, but I’m baffled all the same.

      • Hope lots take legal action, these programs have been operating in a very suspect way from the start, women have been treated disgracefully, yet these programs get away with lying and misleading women, huge numbers harmed in the process.
        It was all avoidable – I hope there is some justice for women – heads should roll if there is any fairness in this world. You should not be able to behave in such an unethical way – I’d say some of the conduct was potentially illegal – arguably amounting to assault – it should not be okay because it was called women’s cancer screening. Coercion is arguably assault, so is excessive pressure to screen or misleading women to screen, releasing manipulated “evidence” – the whole rotten business.

  8. https://www.bmj.com/content/350/bmj.h139/rr-0

    It will be very interesting to see how this all pans out. What has happened so far in the UK:
    By the end of this month, letters will have gone out to all those women (in their 70’s) who have been “affected”. If you don’t receive a letter you are not one of those who missed an invitation to our marvellous screening programme. The letter supposedly includes a warning that mammography at this age can be more harmful than a help. (Flies in the face of why they are extending the programme to 73 year olds doesn’t it?). I’ve seen some women say they won’t be taking up the offer, and others saying they’ve been offered an appointment next October at the earliest, but that assumes they get a full uptake of routine mammography in the meantime. Breast Cancer Now, right wing press and politicians are using it to engage in NHS bashing, but what we don’t hear from are the women themselves. My theory is only a small fraction will take up the offer. Big mystery why the issue was ever brought up at all. Publicise extension trial as a failure? Solicitors and lawyers touting for business from those who think they’ve got cancer as a result. Is it all a trigger to get many to take legal action and bankrupt the programme? But to do this, lawyers would need to prove mammography works. Not sure if it’s not a way to bankrupt programme through claims to shut it down? Very mysterious, and coinciding with the failures on cervical screening recalls in Ireland too, which could bankrupt programme….

  9. Obtained via subscribing for screening updates from Gov.uk/PHE Screening. PHE Screening blogs provide up to date news from all NHS screening programmes. You can register to receive updates direct to your inbox, so there’s no need to keep checking for new blogs https://phescreening.blog.gov.uk/2018/08/15/kpi-data-published-for-end-of-the-2017-to-2018-screening-year/
    https://www.england.nhs.uk/wp-content/uploads/2017/04/service-spec-24.pdf
    This is a lengthy read but none the less I read it, quite a minefield of information and still notice the focus of increasing uptake!

  10. After the furore about the English breast screening scandal where the women weren’t “invited” to their final screen now seems problems has also hit the Scottish programme. …more lives “put at risk”

  11. So why not ask if people want to volunteer to take the BRCA genes test and see if they have a variant that MAY disposition them to breast cancer or other cancers factoring in other risk factors?????? Instead of having these expensive and damaging mammogram screening programmes. For EVERYONE????? Has anyone ever thought of that? Haven’t they collected enough data on breast cancer cases without consent throught the screening programmes or is that data off limits?

  12. Moo I’m sure the screeping programme thinks of nothing but that and keeps it under wraps so more misguided women “accept invitations ” to screening and keep the screener in jobs…

  13. I actually saw a comment from a cervical screening employee on the PHE website asking about possible redundancy during the UK switch to HPV testing….so they’re really concerned about women lol..

    • It can’t happen soon enough! Aren’t they reducing the labs down from about 40 to 8 in UK and the samples can be machine read unlike smears? I’ve seen loads of women posting that many GP surgeries don’t have any appointments for weeks ahead, and then some places have waiting times of 13 weeks before the results come back. 😊

    • I think that’s why we’re still siding with excess and ignoring some of the evidence, to maintain the lucrative colposcopy/biopsy business, those aged 25 to 29 will produce a lot of hpv+ results. We know long standing evidence says no hpv testing before 30, that young women often have transient and harmless hpv infections that will clear in a year or so, they don’t need colposcopies or biopsies.
      I think too, when you’ve been horribly over-screening and lying to women about the need for frequent and early screening, which amounts to bad medical advice, you have to cover your tracks – most of our over-treatment and the harm caused to women was avoidable. Don’t want legal action or heaven forbid, the herd moving away from the screening program. Moving first screen from 18 to 30 was obviously viewed as too dangerous, it might cause a panic or motivate women to take a closer look at the program…and we all know these programs don’t stand up to close scrutiny.

      • In UK some areas, eg Wales, have already switched to HPV as the primary test and also some parts of England, but they won’t change the screening interval until all areas have changed and we may be waiting for a few years yet. So samples will be checked to see if HPV- and then sent a recall for another test in 3 years time. However, I think that the long delays in getting results and booking for an appointment are starting to sink in with some women, that the urgency is a lot of hype.

      • I’d be very keen to know what they’ve got planned, or is there a need for a computer system at all? Have never understood why GP surgeries cannot set up their own systems. It’s easily done now, but wasn’t available in 1980’s. Why do we need this national database of women’s vaginas? Is this not something between the patient and her doctor?
        Complete roll out of HPV testing was planned for April 2019, now postponed for December 2019. Will it be ready by 2020? Very much doubt it. I think we’re stuck with the old system for a while yet, but let’s hope uptake continues to fall and deaths continue to fall, and women wake up and realise the stupidity of it all.

    • https://www.hsj.co.uk/quality-and-performance/decades-old-computer-systems-putting-lives-at-risk/7023536.article#.W8Xe5bNDTeM.twitter

      Kat, I bet legislation is stopping a new cervical screening summons system from being approved. It’s my guess that they can’t get rid of this old wreck of a computer system, because a new system would have to comply with current human rights and data protection, which would allow women more say in how their data is used. The old system is stuck in the 1980’s and our rights have moved on since then.

    • Awareness! You’d have to be dead or a hermit living in a cave not to know about cervical and breast cancer and the screening programs, of course, listening to the PR they trot out on these awareness drives is not going to inform you…much more likely to mislead you. The old guilt trip, admonishing naughty “unscreened” or “overdue” women, scaring us etc. well, it’s getting a lot harder, these trusted tools fall flat on their face when the target population is informed (or more of us are informed)
      I’m aware alright…of the lies, the unethical conduct of these programs and the medical profession, the shocking harm it’s caused to vast numbers of women, and the abuse (coercion, linking the test to the Pill)…that’s the only awareness that interests me.

      • Medicine truly is the last bastion of patriarchy. Its astonishing that with all the gains women have made in recent decades in the workplace, politics, etc., the medical establishment continues to get away with treating us like children incapable of making decisions for ourselves. I believe they play into our deepest fears such as dying from cancer, or loss of fertility (for women who want children), and then use this vulnerability to lead the masses into dubious practices such as pap tests, mammograms, etc. It is heartening that more women are waking up to these unethical tactics and there is certainly hope that more will choose to join us.

  14. Its breast cancer awareness month in the US, and my doctor’s office mailed me a card with pretty pink flowers saying “Schedule Your Mammogram!” How quaint. Because we all know (in Fairy Land) that breast cancer is a pretty pink disease, and if I just go for my mammograms, I’ll be diagnosed early and then be cured, right? Right? And those 40,000 women in the US who die of breast cancer every year (a figure that has remained largely unchanged for decades), most of whom were originally diagnosed at an early stage? Details, schmetails, who needs them? Please excuse my sarcasm – the propaganda in women’s cancer screenings is really getting to me. The truth is out there, if women want to see it, but it seems so many of them want to live in Fairy Land!

  15. Daily fail today ladies…would u trust a £200 home scanner to check your breasts for lumps and cancer? Seems boffins in silicon valley are focusing more on women’s health at the moment. …hmmmm

    • Notice that there are two links on that article that lead to two more articles about the pros and cons of breast screening, as well as one on the shortfalls of breast screening.
      You’d never see similar articles about cervical screening would you?! Despite it being a screening tool for a much rarer disease!

  16. Happy New Year everyone!
    Through my letter box this morning – a summons for breast screening!
    Appointment now cancelled and letter in recycling box.
    I checked that the leaflet did include a contact to opt out. It did. Took me to the UK Gov website where I could phone the breast screening unit and ask to opt out or contact GP. If I have to go and issue is rsised I will demand to opt out.on the spot.

    • Happy New Year! Good for you, Ada. I’m hoping the cervical screening service have received my New Year’s wishes to them – my third signed opt out/disclaimer since November, sent by 1st class ‘signed for’ delivery on Thursday. I will look forward to my confirmation of ‘opt out status’ letter from them shortly…

  17. Over on the PHE blog ..to inspire us with confidence in the breast crushing programme. ..mammography apprentices have been appointed and will start training. Don’t all rush at once now to accept your invitation. ..

  18. Seen this today! Family history OR not, I would not want my breasts radiated & flattened with approx 40 pounds of pressure on a yearly basis, let alone if I had the specific gene mutations! Also of all the so called “family history”…..my thought is, how many were over treatment in the first place?!? This would certainly assist in helping reach their famous targets and most probably increase over treatment?

    https://www.bbc.co.uk/news/health-47193545
    Younger women with a family history of breast cancer should receive annual screenings to pick up the disease earlier, a charity says.
    Breast Cancer Now funded a study which found cancers were detected sooner when 35 to 39-year-olds at risk had annual mammograms.
    NHS screening often starts at the age of 40 for women with a family history.
    Experts need to balance the benefits of doing more checks against causing any undue worry or over-treatment.
    The study’s authors said that more analysis was needed on the risks, costs and benefits of extending the screening programme.
    “For women with a family history, removing a non-invasive tumour so early in their lives is likely to be a cancer preventive,” Professor Evans said.
    The study did not include women who had specific gene mutations which can increase the risk of the disease.

    • People with a special risk don’t need “more screening” which is tailored to people with normal risk anyway, and sucks at what it should do. They need a detailed analysis of their risks and needs, and then make an informed decision about what measures to take.

    • More checks… and then what?! I’ve heard that many high-risk women are being denied the blood tests that screen for the BRCA1 and BRCA2. Some women want mastectomies and hysterectomies due to a strong risk factor. Yet women are denied that. They’re more than happy to hack away at your breast or cervix when there’s nothing wrong with them (or when your risk factor is as low as 15%). NHS needs a radical overhaul. This is ludicrous.

  19. Surprise surprise I have received from NHS Breast Screening……an appt for 22/09/19, again they have assumed I will attend and made the appt in advance. As I did not ask for the appt I shall not be cancelling this. So infuriating to keep getting these! This is the second time now, once at age 47 to enter a trial on screening younger women which I did not attend of course and now again as I have turned 50! What a dam cheek!

    • Annoying isn’t it. Such a waste of time and resources. I didn’t attend my summons on the 30th August. I’ve since received another letter asking me to ring to confirm I’ve had screening elsewhere (?) or to make another appointment. Nope.

  20. It annoys me the absolute cheek of it. Do let us know how long they pester you until the letters stop. It will be at this point that the computer will notify your GP surgery that you have FAILED to attend and to make a tit groping session a priority at whatever your next appointment will be for since you are clearly unable to find them by yourself.

    After what has happened to my sister, I have been tempted to opt out altogether, but in some ways it is good to monitor what the buggers are trying on next. I cancelled my last (and 3rd) summons last January, so not expecting another for a while unless a bowel screening one turns up.

  21. Mint that’s outrageous. I thought if you didn’t attend the 1st summons they just sent another and then left it til the next round? Maybe this is a new tactic to increase uptake or maybe what they do to serial did not attenders?
    Ada I know where you’re coming from and Chas too but I felt obliged to cancel my 1st summons so it could go to someone who actually wanted it and I was so sick of the smear test shit too. I opted out of breast screening immediately after my 1st summons as I wasn’t prepared to keep cancelling unwanted appointments. It’s appalling the way they treat us

    • From previous research it appears that the NHS breast screen always over book these appts anyway, as they know full well a few will not turn up. I have not cancelled it as I’d like to see what happens next, how they deal with non-attenders just to keep up to date with what they are doing….naughty me!

      The booklet sent with the invite & appt states on page 11: about 4,000 women each year in the UK are offered treatment they did not need. For every 1 life saved about 3 are diagnosed with a cancer that would never have become life-threatening.

      You would think/hope that any woman reading that part would be put off a mammogram? Only I really don’t think most women read it through properly!

      • Exactly Chas…and they think us non attenders are stupid and need educating??!!!!! When the treatment involves chemo radiation and other life threatening procedures for something that in all probability would never harm?! Hmmmm

    • It’s my third letter this year! I presume they are desperate to fill their screening slots. It’s bordering on harassment. Ignore. Ignore. Ignore.

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