Mammography - Recommendation against screening programmes in Switzerland: The Swiss Medical Board, an institution equivalent to the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG - Institute for Quality and Efficiency in Health Care) has spoken up against the new introduction of systematic mammography screening programmes, and for the setting of a time limit for programmes already in existence in Switzerland. The reason for this is that the authors believe that the balance of risks and benefits is negative (see a-t 2012; 43: 25-8) (1). On the basis of the available data, critical scientists have, in recent times, repeatedly called to political decision makers to review the pros and cons of breast cancer screening (2-4). The randomised studies currently available, from which a fall of 20% in the relative breast cancer mortality rate due to early diagnosis has been generally deduced, are all several decades old. As they were initiated before the era of modern treatment methods that lead to a considerably improved breast cancer prognosis, they could overestimate the effect of screening. A positive impact on total mortality is not proven anyway. On the contrary, above all there are very frequent false positive findings and overdiagnoses as adverse effects. An overdiagnosis is a carcinoma, discovered by screening, that would not otherwise have been noticed during the course of the patient's lifetime (1, 5). According to a review on 20 screening programmes in 17 countries, quoted by the Swiss authors, the rate of false positive findings, which lead to further diagnostic procedures, and which can imply considerable psychological stress, lies at 4% per screening round. According to the currently published 25-year follow-up of the Canadian National Breast Screening Study, every fifth (21.9%) carcinoma detected by screening could be overdiagnosed (3, 5). The recommendation of the Swiss Medical Board has met with widespread opposition as was to be expected. It is not legally binding. One Swiss canton, however, wants to reconsider the planned introduction of the screening programme in the light of this recommendation (5).

(R = randomized trial)

1

Swiss Medical Board: Systematisches Mammografie-Screening (Systematic mammography screening), report dated 15 Dec. 2013; http://www.a-turl.de/?k=ennh

2

GØTZSCHE, P. et al.: Cancer Causes Control 2012; 23: 15-21

3

MILLER, A.B. et al.: BMJ 2014; 348: G366 (10 pages)

4

KALAGER, M. et al.: BMJ 2014; 348: G1403 (3 pages)

5

BILLER-ANDORNO, N., JÜNI, P.: N. Engl. J. Med.; published online 16 April 2014; doi: 10.1056/NEJMp1401875