Transcripción parcial a PPOINT de la Conferencia de Peter Gotzsche en CBME (Center for Evidence-based Medicine); Oxford. Junio 2014. Material audiovisual de síntesis, con traducción y énfasis sobre comentarios del expositor. Material utilizado como motivador para discusión en grupos. Incluye el video original de la exposición. Disponible en: https://www.slideshare.net/MiguelPizzanelli/peter-gtzsche-oxford-lecture2014the-case-against-screening-in-breast-cancer

2. https://youtu.be/8A9xuLmUHcQ
Peter Gøtzsche
CEBM Oxford. Publicado 3 de junio 2014

10. • Esta revisión sistemática encuentra hasta un 50% de
sobrediagnóstico.

12. • Cuando comenzó el screening en UK en 1988, la incidencia en el
grupo de edad de 50 a 64 se elevó bastante y se mantuvo alta (ver
curva verde).
• Cuando se inicia en la franja de edad 65 a 69 en el 2001, igualmente
ocurre ese fenómeno (curva azul). Lo mas asombroso es que este
grupo de edad ya había sido sometido a screening; ¿Por qué entonces
toda este incremento en la incidencia luego de iniciar screening?
Esto solamente puede explicarse por el hecho de diagnosticar cáncer
poco agresivo (overdiagnosis)

13. Peter Gøtzsche
• La mayor parte de los canceres detectados por screening tienen un
comportamiento clínico bien diferente (mild) a los tumores de mama
que se diagnostican por la aparición de síntomas.
Screening detected VS Clinical detected

14. Harms from breast cancer screening outweigh
benefits if death caused by treatment is included
Michael Baum professor emeritus of surgery, Division
http://sci-hub.cc/10.1136/bmj.f385
Each new intake of medical students to my surgical “firm”
started off with a tutorial where I posed a rhetorical question:
“Why do we screen for cancer?” To which the inevitable answer
would be, “To catch it early, sir.” Wrong. The question should
be reframed, as “Does screening for cancer improve length or
quality of life?” All other outcomes are surrogates.

15. Breast cancer mortality in neighbouring European countries with different levels of
screening but similar access to treatment: trend analysis of WHO mortality database
Philippe Autier https://sci-hub.cc/10.1136/bmj.d4411
Results Sweden and Norway The national organised mammography screening programme
in Sweden was implemented from 1986 onwards after a pilot study and the results of
clinical trials carried out in the country in the 1970s and 1980s (table 1).10 In 1990 about
90% of Swedish women had received a first invitation. Nationwide coverage was attained
in 1997 (fig 1). All women aged 50-69 are invited, but in most counties (60-70%) women
aged 40-49 are also invited.11 In half the counties women aged 70-74 are invited.
Attendance for screening in Sweden has been consistently among the highest recorded in
any country.12 Non-organised screening is uncommon.
The Norwegian organised mammography screening programme was initiated in 1996 as a
pilot project in four counties, which include 40% of Norway’s population (Akershus,
Hordaland, Oslo, Rogaland).13 14 Since then organised screening has been gradually
implemented, with all women aged 50-69 invited every two years. By 2005 the programme
had reached nationwide coverage. For the implementation of nationwide screening the
time difference between Sweden and Norway was about 12 years. Non-organised
screening was uncommon after implementation of the nationwide programme. From 1989
to 2006, breast cancer mortality decreased by 16.0% in Sweden and by 24.1% in Norway
(table 2 and fig 1).

16. ¿Y la mortalidad?

18. Efectos adversos insospechados del screening

21. Dos grandes mentiras
El screening salva vidas
El screening salva mamas

22. Ninguna de las dos respuestas es cierta

24. Pueden verse dos enormes picos en el
número de mastectomías realizadas tras a la
introducción del screening en Dinamarca

25. Hay una forma de reducir la incidencia del
cancer de mama
• Mantenerse alejada del screening

28. ¿Por qué toda esta red de volutarios
traduciendo este documento?
• Porque incluso en sus países la información sobre los programas de
screening esta sesgada y es deshonesta.

29. ¿Qué país tendrá las agallas políticas para
detener el cribado mamográfico?
• Espero que sea mi país, Dinamarca