June 2016

Pros and cons of early detection of breast cancer with a mammogram

Breast cancer is the most frequent type of cancer which affects women in Switzerland and results in more than 1,400 deaths every year. One option of detecting tumours at an early stage is the mammogram. However, this examination does not show whether or not the tumour is malignant and it is therefore controversial. Whereas SP cantonal councillor, Heidi Hanselmann, considers this preventative care to be sensible and important, Gerd Gigerenzer from the Max Planck Institute is opposed to it. He says that a mammogram unsettles patients more than it saves lives.

The argument for

Heidi Hanselmann Heidi Hanselmann, Member of the Cantonal Parliament for SP, canton of St. Gallen

"The 'donna' breast cancer early detection programme for women aged between 50 and 69 was introduced across the board in the canton of St. Gallen in 2010. It is run on a voluntary basis and meets strict quality guidelines. For instance, the mammograms are performed by specially trained experts using state-of-the-art equipment which is subjected to strict controls. Every mammogram x-ray is assessed by at least two doctors. They have to prove that they assess at least 3,000 x-rays a year. The quality and efficacy of the programme is regularly assessed.

The voluntary screening programme is available to all women from all levels of society. All women are given information about the benefits and risks associated with the examinations together with the invitation. In 2014, more than 26,000 women were invited to have the examination. The level of participation is encouragingly high and feedback from the participants is also very positive. More than 99 percent of women surveyed were satisfied with the reception, information and answers to their questions. Basic insurance covers the costs of participants taking part in the screening programme and they do not have pay a deductible.

If no such screening programme is offered, women are given a mammogram at the recommendation of their doctor or because they realise the benefits, for example. This is called opportunistic screening. The x-rays are not organised and assessed as part of a quality-tested screening programme. The women themselves have to bear the costs associated with this screening, meaning that comfortably-off and well-informed women take part more frequently.

I therefore advocate an early detection breast cancer screening programme in our canton, in order to guarantee good-quality healthcare and that all women in our canton have an equal chance of accessing this check-up."

The argument against

Gerd Gigerenzer Professor Dr. Gerd Gigerenzer, Director of the Max Planck Institute for Human Development

"It is claimed that mammogram screening saves lives. However, scientific studies conducted on a total of more than 500,000 women do not support this claim. Women are nevertheless urged to take part and given pink ribbons instead of transparent information.

Screening reduces breast cancer-induced mortality from 5 to 4 per 1,000 women aged between 50 and 70. This is advertised as being a 20 to 30 percent reduction. On the other hand, virtually no women find out that this does not change cancer-induced mortality as a whole – i.e. all types of cancer including breast cancer. Those are the benefits, but what about the damage caused? About 100 women out of every 1,000 without breast cancer are frightened by false alarms and biopsies. In 2 to 10 women out of every 1,000 the breast is partially or fully removed and toxic chemotherapy is often carried out, even though these women do not have progressive breast cancer and so it would never have affected their health. Many doctors are unaware of these benefits and damage. It is therefore important that every woman informs herself and can make her own decision.

We spend billions on early detection of breast cancer, even though there is no evidence to suggest that lives are saved, and many women’s health is in fact negatively impacted. If I were a politician, I would invest these billions of francs in such a way that lives could actually be saved: improve patient safety in hospitals and revolutionise the education system to make young people health literate."

Comments on behalf of Helsana

CEO Schmutz Daniel H. Schmutz, CEO Helsana

"Providing objective and comprehensive information is deeply ingrained in us: 'Providing for the future makes sense'. Preferably from the cradle to the grave. This also applies to medical examinations at first glance: the earlier a cancerous ulcer is detected, the better the chances of it healing.

However, it is worth taking a closer look: you should study the topic in greater detail no later than when studies and expert opinions emerge which question the benefits of such early detection examinations. It takes courage to decide for yourself; these decisions should not be made without careful consideration.

Breast cancer screening is a controversial issue. Studies show that the disadvantages outweigh the benefits. This is the conclusion reached by both Professor Gerd Gigerenzer in his comments and the Swiss Medical Board in its December 2013 report. In spite of this, some cantons fund screening programmes with taxpayers’ money. As the leading health insurance company in Switzerland, we take our responsibility seriously and present the facts. We want to promote personal responsibility and health literacy. It is not about the benefits catalogue of the basic insurance; every woman should decide for herself. However, such a decision should if at all possible be made knowing all benefits and disadvantages. We are committed to objectively informing our customers on breast cancer screening. More topics will follow."