Need to I have a mammogram?

A doctor hunting at mammograms. Photograph: Alamy

It is unpleasant and not always conclusive. About 1 in twenty women are named back for more tests, of whom 1 in six will have breast cancer: but it is not often clear if this breast cancer would have killed you. Turning down any screening feels ungrateful – but probably less so now. Research in the BMJ final week showed that breast cancer screening was virtually as unreliable as screening for prostate cancer, and need to most likely not be offered routinely to ladies in excess of 50.

The paper covered a 25-12 months review in Canada, in which 89,835 girls between the ages of 40 and 59 have been randomly assigned to have 5 annual screening mammograms or taught to self-examine for breast cancer. A complete of 3,250 ladies in the mammography group and three,133 in the self-examination arm designed breast cancer, and 500 in the screening group died compared with 505 in the latter group. So there was no real variation. The researchers showed that mammography overdiagnosed by 22% by finding tumours that in excess of this 25-year period did not create into cancers triggering signs or death. A prior research from Malmo put overdiagnosis of clinically insignificant breast cancers at ten%. In the Uk, women are invited for mammograms every 3 many years if they are amongst 50 and 70 many years of age.

There has been expanding controversy as to how beneficial screening is for some time. A recent report from the Swiss Medical Board stated that regular screening saved 1 or two ladies out of 1,000, but found inaccurate final results in 100 out of 1,000 ladies, triggering psychological anxiety and needless treatment. It suggested that no new breast-screening programmes be set up and that present ones had been given a time limit.

So is this adequate to put you off, or do you believe the benefit of discovering an earlier cancer (which is generally considered to offer you a much better possibility of regular existence expectancy) merits a mammogram?

To have a mammogram or not is a personal choice, and it is now realistic to question no matter whether you should. Specialists have argued over this most recent review, with a Harvard radiologist questioning the high quality of equipment in the study and whether or not girls who were suspected of getting breast cancer have been allotted to the mammogram group. Both would have skewed final results, he says.

In an editorial accompanying the analysis paper, Mette Kalager from the University of Oslo argues that deaths from breast cancer are falling due to better therapies this kind of as Tamoxifen, rather than because of earlier diagnosis by screening. A evaluation in the journal Cancers is really worth reading through simply because it runs by way of important investigation research and their critiques.

So it is fine to be uncertain as to what to do: analysis is displaying that it should be a decision, and not just a provided.

• Dr Luisa Dillner is head of research and improvement at BMJ.

Need to I have a mammogram?