Once again, a health policy bombshell has burst in the Sunday press. The Swiss Medical Board questions systematic breast screening. As was to be expected, the tsunami of outrage arrived on Monday. Apparently, not all interested parties evaluate the same studies or interpret them differently.
What is the “number needed to screen” and the “number needed to hurt”? How many mammograms of what quality must be performed in how many women at what intervals to prevent a woman from dying from breast cancer? Does the interpretation and selection of studies depend on whether the experts’ primary goal is to reduce costs or to prevent as many women as possible from dying of breast cancer? How many women are unnecessarily confused by false positive results? In how many women is carcinoma missed despite the screening program? How many women may be made unnecessarily uncomfortable in order to provide relief to how many women? Is the pretest probability sufficiently high in the group of 50- to 69-year-old women? These questions can obviously be argued about!
The experts argue in public about an emotionally charged topic, and the layman wonders. On the Monday after the publication of the report at 09:00, the first patient already approaches me about the newspaper reports. She said she was upset and unsettled. She says her sister was diagnosed with breast cancer ten years ago at the age of 50 and to date has had no recurrence. Two years ago, she, my now 69-year-old patient, had her annual checkup with a new gynecologist. She had a guilty conscience because she had not had a mammogram for two years. It had been drilled into her that she needed to have annual mammograms. The visit to the gynecologist was very disappointing. The examination had been limited to taking the cancer smear. She had not had to remove her blouse and her breasts had not been examined. For this, she was registered at the hospital for a mammogram. Until today, she had not been under control and she would be grateful if I would recommend another doctor to her.
The public campaigns, discussions and policies cannot do justice to the individual woman. They promote uncertainty. Thus, one woman is afraid of missing a tumor, another of being unnecessarily upset and needlessly made ill.
You, dear colleagues, have the task of advising each individual woman, examining her carefully and taking the measures that meet her needs. You cannot escape this responsibility, now even more so when the experts are arguing.
Cordially, your
Josef Widler, MD
HAUSARZT PRAXIS 2014; 9(2): 1
