Mass diagnostic screening of healthy people is useless and dangerous: The great mammography scam.
This is a short post to recommend the collection of books by Dr. Peter Gotzsche, which I have been reading with great interest. Dr. Gotzsche had been one of the leading figures in public health data review in Scandinavia, until he started voicing dissenting opinions. Then he got cancelled. Wikipedia calls him “disinformation”-spreader - means he is a good guy - in regard to covid vaccines:
is a Danish physician, medical researcher, and former leader of the Nordic Cochrane Center at Rigshospitalet in Copenhagen, Denmark. He is a co-founder of the Cochrane Collaboration and has written numerous reviews for the organization. His membership in Cochrane was terminated by its Governing Board of Trustees on 25 September 2018.[1][2] During the COVID-19 pandemic, Gøtzsche was criticised for spreading disinformation about COVID-19 vaccines.[3]
Books by Peter Gøtzsche can be found on this website, many are available for free download, including the book on mammography screening scam.
From intro by Hazel Thornton:
Our arguments are based on the best available reliable evidence, systematically and thoroughly reviewed and assembled, showing that the known harms of this medical intervention exceed any potential there might be for benefit. Our common desire is that every woman should know that every human being in that or similar position, has the right to make up their own mind to give well-informed consent. Clear, unambiguous, unbiased information, based on the best quality available evidence, including the uncertainties, limitations and consequences that can result from agreeing to be mammographically screened, must be made available. Blind acquiescence to any inducements could cost them dear, as can being led astray by the persuasive, manipulative means used by some of those involved in the screening industry. Availability of suitable adequate information from a trustworthy source other than the promoter is an absolute necessity.
Importantly, the 2nd chapter of the book, Peter Gøtzsche provides a rare insight into how health policies are made, using Machiavellian methods in Denmark and Sweden, with disregard for the evidence.
My work in mammography screening began in 1999 when the Danish National Board of Health asked me to review the randomised trials of mammography screening. There were seven trials, and four of them had been carried out in Sweden.
“Cliff Notes” of the book provided by:
Mammography screening does not reduce overall mortality. The best studies show that women who get screened have about the same chance of dying as those who don't, from any cause. The relative risk for all-cause mortality in well-conducted trials is 1.01 (95% CI 0.99 to 1.04), meaning there's no significant difference. This suggests that even if screening prevents some breast cancer deaths, it might lead to other health problems that balance out any benefit.
There is no reliable evidence that screening reduces breast cancer mortality. When we look at the most trustworthy studies, the reduction in breast cancer deaths is small and could be due to chance. The relative risk for breast cancer mortality is 0.93 (95% CI 0.80 to 1.09) after 13 years, meaning it could range from a 20% reduction to a 9% increase. This uncertainty challenges the core justification for mammography screening programs.
Overdiagnosis is a major harm of screening, affecting about one in three screen-detected breast cancers. This means finding cancers that would never have caused symptoms or death if left undetected. Estimates range from 30% in randomized trials to 52% in organized screening programs. Overdiagnosis leads to unnecessary treatment, including surgery, radiation, and chemotherapy, causing physical and psychological harm to healthy women.
Screening increases the number of mastectomies by about 20%, contrary to claims that it leads to less aggressive treatment. In the UK, there was a 36% increase in mastectomies for invasive cancer and a 422% increase for ductal carcinoma in situ (DCIS) from 1990 to 2001 after screening was introduced. This increase is largely due to the detection of slow-growing cancers and DCIS that might never have caused problems.
False positives are common in mammography screening, affecting 25% of women in the UK and 50% in the USA over 10 screening rounds. A false positive is when a mammogram suggests cancer might be present, but further tests show it isn't. These false alarms can cause significant anxiety, additional invasive tests, and long-lasting psychological distress, impacting women's quality of life and attitudes towards future screening.
Screening has not reduced the incidence of advanced cancers as expected. If screening were effective, we should see fewer late-stage cancers being diagnosed. However, studies in multiple countries have shown no significant decrease in late-stage cancers following the introduction of screening programs. This suggests that screening might not be preventing cancer progression as intended.
The claimed benefits of screening are often exaggerated in both scientific literature and public communication. Some studies have inflated the benefit-to-harm ratio by up to 25 times, often by underestimating harms like overdiagnosis or using flawed statistical methods. This exaggeration has led to overly optimistic views about the effectiveness of screening among both the public and healthcare professionals.
The lead time for breast cancer - how much earlier screening detects cancer compared to symptoms - is much shorter than often assumed, likely less than one year rather than 2-5 years as commonly stated. This shorter lead time means that the window of opportunity for screening to make a difference is smaller than previously thought, which could explain why screening hasn't shown clear benefits in reducing mortality.
Informed consent is often lacking in screening programs. Many invitations and informational materials fail to mention overdiagnosis or present balanced information about both benefits and harms. This lack of comprehensive information makes it difficult for women to make truly informed decisions about participating in screening, raising ethical concerns about these programs.
Conflicts of interest have significantly influenced screening research and policy. Many proponents of screening have financial or professional interests in its continuation, such as radiologists who perform mammograms or organizations that receive funding for screening programs. These conflicts can lead to biased interpretations of data and resistance to evidence that questions the value of screening.
The total cost of screening can be substantial, raising questions about resource allocation in healthcare. In the USA, screening women in their 40s costs $2 billion per year. Given the uncertain benefits and known harms of screening, this level of expenditure is controversial. Some argue these resources could be better spent on other health interventions or on improving breast cancer treatment.
Breast cancer awareness and improved treatments likely account for much of the observed decrease in breast cancer mortality, rather than screening. Mortality has decreased similarly in non-screened age groups and in countries without screening programs. This suggests that factors such as better therapies, faster diagnosis of symptomatic cancers, and increased awareness of breast health may be more important in reducing breast cancer deaths than mammography screening.
Art for today: Late Fall, oil on panel, 11x14 in.
Like a good little girl, I had yearly mammograms and PaP smears exactly as I was told. Looking back I remember the anxiety, the pain, the worry, the expense, the waiting, the follow up ultrasounds, the lumpectomy of benign tissue just because it looked “suspicious.” I gave up a healthy ovary for the same reason, launching me into early menopause for NO GOOD REASON. I am angry thinking of how I was a well insured cog in the endless and brutal medical machine. Boy they saw me coming! Not anymore. I refuse to participate in this mindless manipulation ever again.
Yes. This over-testing/diagnosing/screening is a horrible and harmful situation. Unfortunately, this type of "care" has grown into massive numbers of "for profit" centers that are aimed at extracting the last pfennig from the pockets of we-the-peasants. ...Add, colonoscopy to the list of un-necessary invasive diagnostics. As a board-certified ophthalmologist, I am also certain that one does not need yearly "eye exams"... But, then, I am a heretic.