Harding Center of literacy
Harding Center for Risk Literacy, University of Potsdam, Faculty of Health Sciences
5 out of every 1,000 women aged 50 and over without screening and 4 out of every 1,000 women with screening died from breast cancer over a time period of approximately 11 years.
The numbers in the fact box are rounded. The numbers are calculated from eight studies that included a total of about 600,000 participants .
Screening did not affect the total number of deaths when all potential causes of death are considered. About 84 out of every 1,000 women died in total, independent of whether they were screened or not.
Furthermore, women who receive false alarms (positive test results that turn out to be false positives) can suffer from psychological distress, including anxiety and uncertainty, for years afterward .
A positive result from a mammography does not automatically mean that a woman has cancer. Mammography screening also detects preliminary stages of breast cancer, such as ductal carcinoma in situ (DCIS), which is characterized by abnormal cells in the mammary ducts that have not spread to other tissue (non-invasive). In some women DCIS remains harmless; in others it develops into an invasive tumor, which can be life-threatening .
Any screening can lead to overdiagnosis. In the case of breast cancer, this means that women are diagnosed with breast cancers that would have remained undetected without the screening. One instance of these are small tumors that grow slowly or not at all (non-progressive cancer) and might never have caused any complaints. Because it is difficult for physicians to assess whether a tumor will continue to grow, they often advise their patients to receive treatment.
Overdiagnosis often leads to overtreatment, which means unnecessary surgery or radiation .
 GøtzschePC, JørgensenKJ. Dépistage du cancer du sein par mammographie. Cochrane Database Syst Rev2013(6) doi : 10.1002/14651858.CD001877.pub5.
 IQWIG. Einladungsschreiben und Entscheidungshilfe zum Mammographie-Screening 2014. [www.iqwig.de/de/projekte-ergebnisse/projekte/gesundheitsinformation/p14-03-einladungsschreiben-und-entscheidungshilfe.2019
OMS - a short guide about screening programmes
WHO Screening programmes: a short guide. Increase effectiveness, maximize benefits and minimize harm. Copenhagen: WHO Regional Office for Europe; 2020.
« Screening programmes should provide unbiased and easy-to-understand information so that people can make an informed decision on whether to participate in screening.
Both laypeople and clinicians tend to overestimate the benefits of screening and underestimate the harm of screening. Training personnel on communicating risk and tools such as infographics, videos and decision aids can be used to facilitate understanding and promote informed consent and evidence-informed practice (Fig. 15, p38). » « Fig. 15. Use of infographic to illustrate overdiagnosis in breast cancer screening, » (Above)
Cantaskforce - Canadian Task force on Preventive Healthcare, established by the Public Health Agency of Canada
« Low-certainty evidence indicates that screening for breast cancer with mammography results in a modest reduction in breast cancer mortality for women aged 40 to 74 years with the absolute benefit lowest for women less than 50 years of age. Screening leads to overdiagnosis resulting in unnecessary treatment of cancer that would not have caused harm in a woman’s lifetime, as well as physical and psychological consequences from false positives. »
« Screening is a personal decision. It is important to understand and weigh the benefits and harms for women in your age group (as shown below) with your health care provider. This will help you get a better understanding of the issues so that you can decide what is best for you. Some women may wish to not be screened if they are concerned about potential harms. »
Information on Mammography for Women Aged 40 and Older: A Decision Aid for Breast Cancer Screening in Canada” is a product of the Canadian Breast Cancer Screening Initiative (CBCSI). The CBCSI is a part of the Canadian Breast Cancer Initiative. The Initiative includes the Public Health Agency of Canada, provincial/territorial breast screening programs, professional associations, non-governmental organizations, and women.
Australia (Breast Cancer Screening, it's your choice)
Breast cancer screening decision aid for women aged 50, updated in 2017
Its' your choice
Authors: Jolyn Hersch, Members of the Screening and Test Evaluation Program at The University of Sydney
Abstract: Why is there a decision to make about having breast cancer screening? Many people think screening for early signs of breast cancer is always a good thing. But breast screening has advantages and disadvantages. This booklet is designed to help you make an informed choice about whether you would prefer to have screening or not.This booklet was developed in 2013 by members of the Screening and Test Evaluation Program at The University of Sydney, Australia. It was developed and evaluated as part of a research study which has been published in the following article: Hersch J, et al. Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial. Lancet 2015; 385: 1642. The booklet was updated in 2017 to reflect the extended age range for screening.
This leaflet was developed by an independent team of information experts at King’s Health Partners, with advice and writing support from Cancer Research UK. Through a public consultation, over 1000 members of the public contributed to developing the approach to information about the NHS cancer screening programmes. The information in this leaflet used recommendations from a citizens’ jury of 25 women about how to present the possible benefits and risks of breast screening.
Process described here :
Forbes, Lindsay JL, and Amanda-Jane Ramirez. “Offering Informed Choice about Breast Screening.” Journal of Medical Screening, vol. 21, no. 4, Dec. 2014, pp. 194–200, doi:10.1177/0969141314555350, https://journals.sagepub.com/doi/pdf/10.1177/0969141314555350
NHS Breastscreening - Helping you decide
« It is your choice whether to have breast screening or not. This leaflet aims to help you decide. »
US-US Preventive Services Task Force
Breast Cancer Screening: Benefits and Harms
Author : Jin Jill
JAMA Patient Page
JAMA. 2014;312(23):2585. doi:10.1001/jama.2014.13195
Balancing Benefits and Harms
The pros and cons of breast cancer screening are different for everywoman.
Eachwoman also has different personal values, especially toward the idea of unnecessary
medical tests and treatments.
An interactive online tool for decision-making and risk assessment based on your personal data, free access, which offers you a calculation of your risk and a decision-making tool with benefits and risks, depending on whether you want to do no screening, a biennial or annual screening. Below is a simulation with the example of a 50-year-old African-American woman with a family history and breast biopsy in her history, with high breast density.
You thus follow the successive steps, you enter your personal data and access a risk calculation as well as a personalized point visual.
This decision aid is recommended by the Ottawa Hospital Research Institute and meets the international IPDAS criteria. See the link: https://decisionaid.ohri.ca/AZsumm.php?ID=1881
Brustkrebs-Früherkennung – Herausgeber: Techniker Krankenkasse, Hauptverwaltung: 22291 Hamburg; in Kooperation mit dem Nationalen Netzwerk Frauen und Gesundheit. Internet: www.tk.de. Konzept + Text: Dr. Eva Schindele, Bremer Medienbüro. Wissenschaftliche Beratung: Prof. Dr. med. Ingrid Mühlhauser, Universität Hamburg, 2013
Text EN, page 17-18
Earlier diagnosis does not always lead to a longer life span. As this model calculation shows, in this case only the time of diagnosis was brought forward, thereby extending the disease phase by three years. In both cases, the woman dies at the age of 65.
"The earlier breast cancer is detected, the better." You can read this sentence everywhere, and it makes sense at first glance. But isn't it true?
Prof. Dr. Ingrid Mühlhauser , Hambourg University: “Early detection only has an advantage if early therapy can prevent death from breast cancer. However, according to current knowledge, early detection mammography mainly detects forms of breast cancer that often would not have had a worse course of disease if they had been detected later. In contrast, particularly malignant forms of cancer are often not detected by mammography in time to avert death. Only the time of diagnosis is brought forward and thus the period of time in which the woman lives as a breast cancer patient is extended.”
What does it mean for women when the time of diagnosis is brought forward?
Prof. Dr. Ingrid Mühlhauser : “Imagine that breast cancer is diagnosed at the age of 60. The affected woman dies of the cancer five years later, at the age of 65. With early detection mammography, the cancer could possibly be detected three years earlier, i.e. at the age of 57. If this woman then dies at the age of 65, early detection would not have prolonged her life. It would only have prolonged her time as a breast cancer patient and possibly her period of suffering.”
BreastScreen Norway is a voluntary programme where women between 50 and 69 years are invited to have a breast cancer check in the form of a mammogram (X-ray imaging of the breast) once every two years.
Perception and reality
How women perceive screening data, guided by optimistic slogans and presentations, versus reality https://cancer-rose.fr/en/2020/12/18/perception-and-reality-2/
Reference: Biller-Andorno, Nikola; Jüni, Peter Abolishing Mammography Screening Programs? A View From the Swiss Medical Board, Obstetrical & Gynecological Survey: August 2014 - Volume 69 - Issue 8 - p 474-475