Ethics in Medicine

Risk/Benefit Ratio of Mammograms Being Questioned

Kristen Sparrow • March 31, 2009

In an article from the NYTimes titled “Benefits of Mammograms Under Debate in Britain” the author discusses the controversy raging over information pamphlets handed out to patients on the benefits of mammograms in the UK. ( A group of advocates and experts complain that the pamphlets are not truthful and exaggerate the benefits of mammograms and understate the risks.
What women are not told… is that for every woman whose life is saved by breast cancer screening, up to 10 healthy women are given diagnoses — and, often, surgery — for a cancer that is so slow-growing it would never have threatened a woman’s life….

Mammograms have been accepted as such a basic tenet of preventative care for women over the age of 40 in the U.S. , that questioning the benefit is startling to many here. I touched on this topic when discussing the newly questioned benefit of PSA testing. (

I’ve personally refused mammograms over the years and have encountered only astonishment and disbelief that I would avoid such a life saving exam. From reading I had done, I wasn’t convinced that for a person like myself, with zero risk factors, the benefit would outweigh the risk, and now the data seem to support that stance. Indeed, Dr. Peter C. Gotzsche the author of the Cochrane analysis study states, “It may be reasonable to attend breast cancer screening with mammography, but it may also be reasonable not to attend.” And Dr. Lisa Schwartz from Dartmouth says “You’re not crazy if you don’t get screened, and you’re not crazy if you do get screened”…People can make their own decision, and we don’t need to coerce people into doing this (mammography.)”

I will be fascinated to watch the reaction to this issue by HMO’s like Kaiser. Will they change their policies?
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