Frank words about breast screening

A growing body of evidence suggests that the benefits achieved by screening for breast cancer are small, that the harm from the overdiagnosis of breast cancer arising from screening is substantial, and that, where screening is available, the observed reductions in breast cancer mortality arise largely from increased awareness and improved chemoand hormone therapy.1 In spite of these new insights, screening advocacy continues in full crescendo. For example, in 2010 the Canadian Breast Cancer Foundation Ontario (CBCFO) released a report on its recent consensus conference, “It’s About Time,” focusing on the earlier detection and diagnosis of breast cancer. The CBCFO is a not-for-profit organization; its conference scientific advisory committee consisted of five members, of whom three are active in breast imaging and a fourth is the director of cancer screening at the American Cancer Society. The breast cancer screening recommendations for women at average risk that emerged from the conference are that screening should be done within an organized program and should begin at “approximately” age 40. (“Approximately” may leave wiggle room for women in their 30s to participate.) The “preferred” modality described is annual digital mammography, and if it is not available, film mammography is the alternative.