BREAST SCREENING - THE CASE FOR PHYSICAL-EXAMINATION WITHOUT MAMMOGRAPHY

Many studies have shown that screening for breast cancer can reduce mo rtality from the disease. Mammography has come to be regarded as the s creening method of choice, but evidence Suggests that physical examina tion (PE) is at least as effective in reducing mortality. Mammography detects many noninfiltrating and small, non-palpable tumours, but we d o not know whether these would ever cause symptoms or threaten the wom an's life. It is doubtful whether the time gained by early mammographi c detection confers any survival benefit over PE detection. PE has sub stantial advantages over mammography in terms of human and economic co sts. The question we should be asking is not how to refine mammographi c screening but whether we need it at a all.