Benefits and harms of screening: Overdiagnosis and anticipatory medicine – A secondary publication

Abstract

The treatment of breast cancer has changed markedly since the publication of works that recommend screening for the early diagnosis of breast cancer. Retrospective reevaluations have revealed errors in screening; moreover, advances in oncological therapy and a better understanding of the disease have raised doubts toward the efficacy of these procedures, which might also cause side effects alongside the risk of overdiagnosis and overtreatment. On the other hand, the lack of information or even misinformation might cause confusion among the potential beneficiaries of these procedures, particularly the patients. These procedures are constantly being recommended by institutions, but the possible risks accompanied by these procedures are often not explained. It is easy to promote mammography screening if the majority believe that it reduces the risk of breast cancer and saves lives. Unfortunately, this is not the case. Many critics of screening are now demanding clear and precise explanations of the procedure and emphasizing on the importance of physical examination. Women must make informed decisions before screening by discussing their own risk profile, the possible benefits, and the eventual risks and harms of mammogram with their physicians. Women should be classified into two groups: those who would gain potential benefits from the procedure and those whose risks outweigh the benefits. A screening program that clearly does not offer more benefits than risks cannot be implemented by public heath institutions. Providing complete and unbiased information, promoting appropriate care, as well as preventing overdiagnosis and overtreatment would be the best option.