Another side to mammograms: the German perspective

Whereas the Americans are debating about increasing the starting age of mammography screening from 40 to 50, some countries in Europe are debating about getting rid of routine mammogram screening. Let us take the example of Germany, a rather late comer into the mammogram scene. This country only started its mammography program to screen for breast cancer in 2005, for women between 50 and 69 years of age. But now health experts and politicians are asking: is it working?

The respected German newspaper Die Zeit presented a graphical statistics of how mammography works. I did my best to translate this into English.

For every 1000 women screened by mammography in the time period of 20 years, 300 cases will be considered as possibly positive. Of these 300, 100 cases will test positive after additional tests. Further testing by biopsy will confirm that 50 cases are positive for breast carcinoma.

Of those 700 cases which tested negative in the original screening, 15 will actually turn out to be positive for breast carcinoma.

Thus, from the original 1000 women screened, 65 will be eventually diagnosed with breast cancer. Of these 65, 50 will survive and 15 will not, most probably the 15 cases that were not diagnosed in the first place. Of the 50 survivors, only 5 can fully attribute their survivorship to early screening. 40 cases would have survived with or without screening and the remaining 5 would be cases of overdiagnosis.

Thus, the statistical analysis concluded that

• for every 1000 women screened, mammography will eventually save 5 lives.
• 15 cases of false negatives that lead to death are 3 times as high as surviving cases.
• for every life saved by the screening, there is one case of overdiagnosis due to the screening

What is also interesting is the fact that women in Germany seem to be not that keen about mammograms. This, despite the fact that the procedure is paid by the health insurance and despite the fact that the women actually receive an “invitation” for the screening by mail. European Union guidelines recommend that 70% of the women in the age group 50 to 69 should be screened for breast cancer by mammogram. German figure towards the end of 2007 was 52.6%.

Thus, the ongoing debate questions the effectiveness of mammography in early detection of breast cancer and lowering mortality rates. Is it worth the 400 million Euros spent each year? It is a very difficult question to answer. Many would say that saving human lives has no price. Others would argue that the money is better spent on other more serious life-threatening diseases or in developing more reliable and efficient screening methods. What do you think?