Breast cancer is made out to be a nightmare for all women. It is said to be a devastating disease.There have been even suggestions that women after the age of thirty or so, having finished with the biological need for their breasts, should get them removed and replaced by beautiful prostheses, to avoid future cancers. I wish the human body worked according to our whims and fancies. The truth is that women have a higher chance of getting heart attacks than breast cancers. Coronary heart disease in women has not been properly documented and has always been under-diagnosed and under-investigated. Recent data suggest that women get as many heart attacks as men and they may have a more severe course of the disease.

Many people think that the best bet for a cure in breast cancer is early diagnosis. Mammography has the capacity to detect small lesions in the breast ( which may be cancer ) at an early pre-symptomatic stage. One of the studies ( Breast Cancer Detection Demonstration Project ) did show that 0.5% of the 2,50,000 women screened did show early cancer. This was advertised by the media and the vested interests as proof of benefit to humanity. The million dollar question is if this kind of putative diagnosis benefits patients in terms of overall longevity!

Despite this fact the results were being advertised by the media and television in America thus:

• Most women with breast cancer could be saved by detection....with mammography.
• Mammography helps your doctor see breast cancer before there is a lump when the cure rate is 100%.
• If you are over 35 and haven’t had a mammogram, you need more than your breasts examined.

All the above advertisement are wishful thinking. Statements like the above have raised public awareness resulting in a clamour for mammography requests. There have been sane advice, even in America, by thinking doctors for more caution in this regard, but the latter has mostly been ignored by the media and never reached their targets. There are very disturbing issues involved in this and a recent large study, in addition to many smaller studies, has drawn our attention to the potential hazards of this luxury.

When analysed in terms of population benefits, the three important studies showed that to save one woman from breast cancer per year we have to screen 7086 women unnecessarily ( Health Insurance Plan of NewYork ), or 63,264 women unnecessarily ( MALMO Study), or all the population in a country ( infinity) according to the Canadian Breast Cancer Screening Study. These figures give us an idea of the foolishness of this screening procedure.

In addition the last study quoted above gave the following startling figures:

• 5% of the mammograms are positive or suspicious.
• Of the positive people 80-93% were false positives. This caused much unnecessary anxiety and even surgical removal of the normal breasts.
• 11% of the screenings were false negative. They showed a normal scan when there was a cancer already there and this gave the patients a false sense of happiness while the cancer could grow unimpeded.
• The annual cost of one single life saved was around $ 1.2 million and Sterling pounds 5,58,000 or in Indian Rupees 3 crores. How many countries in this world can afford this?

The study concluded " In the allocation of limited resources, public health policy on a proposed mass population intervention must be based on a critical analysis of the benefits, harm, and the cost. Since the benefit achieved is marginal, the harm caused is substantial, and the costs incurred are enormous, we suggest that public funding for breast cancer screening in any age group is not justifiable." ( emphasis mine).

In fact another study of the audit of mammography in Sweden had shown more damaging results than the Canadian study reported above. I hope our medical men and women wake up to critically appraise many of these methods before we do more damage to our people. None of the screening methods will have any useful role to play in either predicting the future events in a man’s life or even in avoiding what are called the avoidable deaths. The only avoidable deaths that I know of are traffic accident deaths, about which the society seems to do very little.

Let our politicians try and give people clean drinking water and enough food to eat and, if possible, avenues for earning their daily bread. Diseases will look after themselves if we can avoid the two most important risk factors, tobacco smoke and alcohol. The latter are the darlings of our leaders and one can hope to have them with us always! God save mankind on this planet. The medical politicians will want the hi-tech screening methods even in remote hospitals. ( Wright CJ, Mueller CB., Lancet 1995;346:29-32.)