The Politics of Women's Health

Mammography Screening Controversy

Mammograms are heavily promoted as the key to breast cancer prevention, but their value in detecting breast cancer and saving lives is fiercely debated within both the medical profession and breast cancer organizations. And, however you see the issue, it is clear that mammograms are a detection method. They do not prevent breast cancer. Only finding and eradicating the causes of the disease will do that.

For years studies have come to conflicting conclusions about the value of screening mammograms (as opposed to diagnostic mammograms, which are given to women who have a breast lump or other symptom that requires investigation), but for various reasons these results have garnered little media attention. Mainstream breast cancer organizations, the American Cancer Society, and government institutions like the National Cancer Institute, firmly insisting that mammograms are the best available tool for early detection, have resisted pressure to look at the limits of the technology. In response, breast cancer activists have insisted that we face and address the limitations of current screening practices and the risks of unnecessary biopsies and treatments.

Eight randomized controlled trials have been performed in the United States, Canada and Europe evaluating the ability of screening mammograms to decrease the mortality (death rate) from breast cancer as well as overall mortality.  Looking at overall death rate, not just death from breast cancer, is essential as it also evaluates whether the screening test and any subsequent treatment may be causing other harms.  Overall, the early studies were felt to show a 30% reduction in the risk of dying from breast cancer in those women who were in the group screened by mammography.  In 2001 a critical review of all eight trials by the Cochrane Collaboration was published in the medical journal Lancet pointing out flaws in many of them. Six of the eight trials were felt to be sufficiently flawed to invalidate their results.  The Cochrane Collaboration then pooled the results of the 2 remaining studies and found no evidence to support the use of screening mammography.  The U.S. Preventive Services Task Force (USPSTF) then evaluated the trials also.  Although recognizing many of the same flaws, the USPSTF felt only one trial was flawed to the point of invalidating the results.  They pooled the results of the remaining trials and found a 16% reduction in the risk of dying of breast cancer in the women in the screened group.

The latest meta-analysis, published in 2006 by the Cochrane Collaboration, confirms that screening does slightly reduce breast cancer mortality but also leads to overdiagnosis and overtreatment of breast cancer. The review's writers summarize their findings as follows:

"(F)or every 2000 women invited for screening throughout 10 years, one will have her life prolonged. In addition, 10 healthy women, who would not have been diagnosed if there had not been screening, will be diagnosed as breast cancer patients and will be treated unnecessarily. It is thus not clear whether screening does more good than harm. Women invited to screening should be fully informed of both benefits and harms."

Making sense of both the complex research and the politics of research funding and treatment can be complicated and confusing. We’ve gathered some resources to help understand the controversy surrounding the value of mammograms, make personal decisions about whether to have a mammogram, and provide insight into the politics of the breast cancer industry.

• One of the best sites for information is Breast Cancer Action, an organization at the forefront of the breast cancer activist movement. BCA believes that women are entitled to, and must demand, better screening tests and true prevention strategies. Their website is stocked with information analyzing the breast cancer industry, interpreting scientific data, and educating women about the realities of breast cancer. Their Policy on Breast Cancer Screening and “Early Detection”  gives a great overview of the mammography screening controversy and has links to other resources.
  
  
• The National Breast Cancer Coalition is another activist organization; their Position Statement on Screening Mammography details their reasoning behind their stance that there is “insufficient evidence to recommend for or against screening mammography in any age group of women.”
  
  
• The Center for Medical Consumers, a New York City-based not-for-profit advocacy organization, believes that screening mammograms may cause more harm than good by leading to the diagnosis and aggressive treatment of dormant cancers as well as invasive cancers that would never become symptomatic. See their article Mammography Screening—Both Good and Bad News, as well as associate director Maryann Napoli’s interviews of two breast cancer researchers who call attention to the slight increase in breast cancer deaths shown in women given mammograms in all of the randomized clinical trials.
  
  
• The 10/15/03 edition of the Journal of the National Cancer Institute highlights mammography screening. The issue includes point and counterpoint articles on whether women have enough information to give true informed consent for mammograms.
  
  
• And finally, if the politics, priorities, and limitations of breast cancer research make you angry, check out activist Barbara Ehrenreich’s speech from a 2002 Breast Cancer Action meeting. Ehrenreich, who has breast cancer, lambasts the breast cancer industry and provides a funny, scathing indictment of breast cancer culture. Her speech is a call to arms for a return to the anger, militancy, and activism of the women’s health movement in the 1970s.

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