DÄ internationalArchive1-2/2019The Result is a Zero-Sum Game
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“The value of mammographic screening is confirmed in the updated guideline,” write the authors (1). Later, however, they state that evidence for the reduction of breast cancer mortality due to the screening is highly inhomogeneous. Notwithstanding this, participation in the German Mammography Screening Programme is recommended.

A reduction in breast cancer mortality through participation in the screening was “also” demonstrated for women between the ages of 40 and 49, although unfortunately no absolute risk reduction was given. Screening healthy women between the ages of 50 and 69 could save up to eight out of every 1000 women from dying from breast cancer over the next 20 years (10 screening rounds). However, this figure clearly contradicts the results of the Nordic Cochrane Center (2).

Unfortunately, nothing is said about all-cause mortality in women. Taking all-cause mortality of women into consideration, the result is a zero-sum game (3).

Evidence for a reduction in breast cancer mortality is currently insufficient for other imaging tests and is very inhomogeneous for mammography, but apparently this is enough for mammography to be recommended. One can remain skeptical. Figure 1 in the article (showing the relative five-year survival versus tumor stage) suggests that early detection is beneficial, yet says nothing about mortality. Tumor biology remains decisive. Rather than the S3 guidelines recommending participation in screening, one should consider how to get out of a program based on “inhomogeneous evidence” and invest money in basic research instead.

DOI: 10.3238/arztebl.2019.0009a

Peter Bußmann

Facharzt für Geburtshilfe und Frauenheilkunde, Ense

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Wöckel A, Albert US, Janni W, Scharl A, Kreienberg R, Stüber T: Clinical practice guideline: The screening, diagnosis, treatment, and follow-up of breast cancer. Dtsch Arztebl Int 2018; 115: 316–23 VOLLTEXT
2.
Gøtzsche PC, Hartling OJ, Nielsen M, Brodersen J: Screening for breast cancer with mammographie. The Nordic Cochrane Center 2012. www.nordic.cochrane.org/sites/nordic.cochrane.org/files/public/uploads/images/mammography/mammography-leaflet.pdf (last accessed on 27 June 2018).
3.
Biller-Andorno N, Jüni P: Abolishing mammography screening programs? A view from the Swiss Medical Board. N Engl J Med. 2014; 370: 1965–7 CrossRef MEDLINE
1.Wöckel A, Albert US, Janni W, Scharl A, Kreienberg R, Stüber T: Clinical practice guideline: The screening, diagnosis, treatment, and follow-up of breast cancer. Dtsch Arztebl Int 2018; 115: 316–23 VOLLTEXT
2.Gøtzsche PC, Hartling OJ, Nielsen M, Brodersen J: Screening for breast cancer with mammographie. The Nordic Cochrane Center 2012. www.nordic.cochrane.org/sites/nordic.cochrane.org/files/public/uploads/images/mammography/mammography-leaflet.pdf (last accessed on 27 June 2018).
3.Biller-Andorno N, Jüni P: Abolishing mammography screening programs? A view from the Swiss Medical Board. N Engl J Med. 2014; 370: 1965–7 CrossRef MEDLINE

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