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Sammanfattning

The rationale för mammography screening no longer exists. A systematic review of seven countries, including Sweden, did not find a reduction in the occurrence of advanced cancers, which is a prerequisite för screening to work. Rigorous observational studies have failed to find an effect of screening; in fact, the observed declines in breast cancer mortality have been largest in young age groups that are not invited to screening, and they are unrelated to the introduction of screening. Tumour data from the old randomised trials show that the effect of screening 20-30 years ago cannot have been larger than a 12% reduction in breast cancer mortality. If there is any effect today, it is marginal and could be counteracted by the life-shortening effect of radio- and chemotherapy when given to the many overdiagnosed healthy women. Recent studies have shown that many of the screen-detected cancers would have regressed spontaneously without treatment. What is more important than catching cancer »early« is therefore to reduce its occurrence. The most effective method to achieve this is to stop the screening programme. With an overdiagnosis of about 50%, as found in a systematic review of countries with organised screening programmes that also included Sweden, stopping screening would reduce the incidence of breast cancer by one third in the screened age groups.

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