Call for a rethink on breast screening

AUSTRALIA’S breast-screening program should be reassessed to make sure it is not causing more harm than good, leading epidemiologists say.

The deputy director of the Women’s Health Research Program at Monash University, Professor Robin Bell, said it could be argued that women should no longer be routinely invited to have mammograms because of the significant risks of ”over-diagnosis”.

On Tuesday an independent panel of experts in Britain said that for every life saved by its breast-screening program, another three women would be over-diagnosed and treated unnecessarily for cancer that would never have caused them harm. This meant the program was preventing about 1300 breast-cancer deaths every year while causing 4000 women to be over-diagnosed.

The experts said that while the benefits of the program still outweighed the harm, women should be given detailed information about the risk of over-diagnosis to make a more informed decision about screening. They also called for a reassessment of the cost-effectiveness of the screening program.

In response to the British findings, Professor Bell said Australia needed to rethink its approach to breast screening because the balance of harms and benefits had shifted considerably since the BreastScreen program began in the 1990s.

While the British panel used data from the 1970s and ’80s to estimate a 19 per cent rate of over-diagnosis through breast screening, Professor Bell said more recent Australian research suggested 30 to 40 per cent of cancers detected in the BreastScreen program were over-diagnosed.

This meant the ratio of lives saved to over-diagnoses could be one to six in Australia, as opposed to the British estimate of one to three. Given that a screening program has to produce more benefits than harms to be viable, she said it could be argued that Australian women in their 50s and 60s should no longer be invited to attend screening because the invitation implies the benefits outweigh the risks.

The government could still provide free access to mammograms for women who wanted them, she said, particularly those with a strong family history of breast cancer.

A spokesman for the Health Minister, Tanya Plibersek, said the government’s Intergovernmental Standing Committee on Screening was monitoring emerging evidence about the harms and benefits of breast screening.

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