1. Switzerland debates dismantling its breast cancer
screening programme
Sophie Arie
London
A row has erupted in Switzerland after the Swiss Medical Board
recommended that the country’s mammography screening
programme for breast cancer be suspended because it leads to
too many unnecessary interventions.
In a report made public on 2 February, the board said that while
systematic mammography screening for breast cancer saved
1-2 women’s lives for every 1000 screened, it led to unnecessary
investigations and treatment for around 100 women in every
1000.1
“The desirable effect is offset by the undesirable effects,” said
the report, which was based on study data from 1963 to 1991
comparing 1000 women who were screened with 1000 women
who were not. The report also concluded that screening was not
cost effective.
The board was founded by the health ministers of the Swiss
cantons, the Swiss Academy of Medical Sciences, the Swiss
Medical Association, and the government of Lichtenstein in
2011 to offer independent expert medical advice. Its report
recommended that no new systematic mammography screening
programmes be introduced in Switzerland and a time limit be
set on existing programmes.
Leading cancer organisations in Switzerland strongly rejected
the report, and it is not clear if any of its advice will lead to a
change of policy.
The Swiss Cancer League said it was “astonished” at the report,
arguing that it was based on old data, its methodology was
flawed, and it went against the global consensus, which is in
favour of screening.
“Like numerous national and international experts and
organisations (WHO, EU), the Cancer League believes that the
pros outweigh the cons,” the organisation said in a statement.
Swiss Cancer Screening said that the report used exactly the
same data that have led respected experts worldwide to reach
the opposite conclusion. It criticised the board for questionable
methodology, overemphasis on certain studies, and inaccurate
calculations.
In 2013 Switzerland adopted a national strategy against cancer,
recommending systematic screening for women over 50. Eleven
of the country’s 26 cantons have put screening programmes in
place, some only within the last year. The Federal Public Health
Office said it saw no reason to change that strategy but, it said,
every effort must be made to improve the quality of
mammography screening.
Debate has grown in recent years over the benefits and
disadvantages of breast cancer screening. The BMJ published
a large Canadian study on 11 February, based on more recent
data, that drew similar conclusions to those of the Swiss Medical
Board.2
In the UK, the parliamentary Science and Technology
Committee is reviewing the evidence underpinning all national
screening programmes and is accepting submissions for the
review up to 26 February.3
The Netherlands recently reviewed its screening programme
and concluded, on 26 January, that the “advantages [of
mammography screening] outweigh the disadvantages.”4
1 Swiss Medical Board. Systematic mammography screening. 15 Dec 2013. www.medical-
board.ch/fileadmin/docs/public/mb/Fachberichte/2013-12-15_Bericht_Mammographie_
Final_Kurzfassung_e.pdf.
2 Miller AB, Wall C, Baines CJ, Sun P, To T, Narod SA. Twenty five year follow-up for breast
cancer incidence and mortality of the Canadian National Breast Screening Study:
randomised screening trial. BMJ 2014;348:g366.
3 Wise J. MPs are to review evidence on screening programmes. BMJ 2013;347:f7557.
4 Health Council of the Netherlands. Population screening for breast cancer: expectations
and developments. 2014. Publication no. 2014/01. www.gezondheidsraad.nl/sites/default/
files/summary_BV_Borstkanker_verwachtingen_en_ontwikkelingen_0.pdf.
Cite this as: BMJ 2014;348:g1625
© BMJ Publishing Group Ltd 2014
For personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe
BMJ 2014;348:g1625 doi: 10.1136/bmj.g1625 (Published 18 February 2014) Page 1 of 1
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