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Tumor Discovery Benefits and harms of screening breast cancer

Three other instances of how language is used to private medical societies, and organizations, which do not
underline the benefits of screening are as follows: doubt the excellence of the system, we must, in this case,
(i) presenting the benefits in relative rather than absolute think as follows: “It does not smell rotten in Denmark,”
terms; (ii) comparing increases in 5-year survival rates but rather it smells like “sardines being pulled up by their
with decreases in mortality rates; and (iii) showing that the own bootstraps”. and how can they throw stones, not even
women who are screened by mammography are referred to sardines, at their own roof?
as patients, who could be healthy people. It is noteworthy that the primary objective of a breast

5. Marketing and its benefits: Political cancer prevention plan in a specific autonomous community
profitability is the participation of at least 70% of women who have
been invited to participate. If that is the objective, to ensure
The information women receive when they are invited to maintenance budgets, how is screening supposed to be
participate in mammography screening tends to be biased, recommended to women in an unbiased manner? On the
insufficient, and misleading. other hand, there were no assessments for tumor detection,
false-positives, adverse events, unnecessary interventions,
Information on the internet, for instance, on cancer
fundraising websites, often omits the harms or portrays etc. Even the indicator “cancer detection rate within the
program” was specified as “Not available” in the findings.
them as the benefits.
Clearly, it takes 10 years and 2000 women to get three!
These invitations generally focus on the benefits of
The last objective, which is the ninth on the list, is to
screening, rather than providing information on the improve the training and knowledge of professionals and
proportion of healthy women who are overdiagnosed or the general public on preventive aspects of cancer. However,
overtreated.
it does not seem that this objective can be achieved either.
When women are invited for mammography screening, [12]
Prasad et al. have recommended that health-
the common practice is that when they receive the letter, care providers should be frank about the limitations of
they are also given an appointment for the examination. screening. The first step public health experts should take
This puts pressure on women, and thus, their participation is to convey the message that mass screening of healthy
in screening is less voluntary. In some countries, women people for cancer is not equivalent to health preservation.
are even telephoned at home and encouraged to participate, To say explicitly or implicitly that screening saves lives
which is also potentially coercive.
when there is no evidence to support this claim and much
Screening is said to reduce a woman’s risk of losing to the contrary undermines confidence toward the medical
her breast. This is a false fact. Instead, screening increases profession.
the risk of lumpectomy or mastectomy as a result of
overdiagnosis and overtreatment. 8. Conclusion
6. The collectives From an ethical perspective, it would be difficult to justify
the implementation of a public health program that clearly
Support groups, organizations, advertising campaigns, does not bring more benefit than harm. Providing clear
community screening events, etc., consider universal and unbiased information, promoting appropriate care,
screening as an advance or a social achievement, without and preventing overdiagnosis and overtreatment would be
having awareness of the risks of overdiagnosis. Added the best option.
to this is the fact that the information they receive is Women, physicians, and health-care policymakers
incomplete and sometimes false, exaggerating the benefits should carefully consider the trade-offs when deciding
and concealing the disadvantages and, above all, the risks. whether to participate in screening programs.
They do not understand that in this case, “less is more
and more is less.” Direct access to “non-suspicious” and Given all of that, we are not implying that all cancer
independent information, such as that provided by the screening is futile. People with a higher baseline risk of
NBCC or the Nordic Cochrane Center , could reassure cancer, such as those with a family history of cancer or
[6]
[12]
some sensitivities. environmental exposure, may benefit from screening.
Similar to Prasad and the NBCC [6,12] , we believe that it is
7. Sociopolitical profitability advisable to invest money in research for such patients.
Although we consider that professionals should be familiar It is understandable that some people, even with
with all publications on the subject, and despite the objective data at hand, still prefer to be screened. There
number of existing screening programs in communities, is also much to be debated on concerning who should

Volume 1 Issue 2 (2022) 4 https://doi.org/10.36922/td.v1i2.228