Switzerland debates dismantling its breast cancerscreening programmeSophie Arie

London

A row has erupted in Switzerland after the SwissMedical Boardrecommended that the country’s mammography screeningprogramme for breast cancer be suspended because it leads totoo many unnecessary interventions.In a report made public on 2 February, the board said that whilesystematic mammography screening for breast cancer saved1-2 women’s lives for every 1000 screened, it led to unnecessaryinvestigations and treatment for around 100 women in every1000.1

“The desirable effect is offset by the undesirable effects,” saidthe report, which was based on study data from 1963 to 1991comparing 1000 women who were screened with 1000 womenwho were not. The report also concluded that screening was notcost effective.The board was founded by the health ministers of the Swisscantons, the Swiss Academy of Medical Sciences, the SwissMedical Association, and the government of Lichtenstein in2011 to offer independent expert medical advice. Its reportrecommended that no new systematic mammography screeningprogrammes be introduced in Switzerland and a time limit beset on existing programmes.Leading cancer organisations in Switzerland strongly rejectedthe report, and it is not clear if any of its advice will lead to achange of policy.The Swiss Cancer League said it was “astonished” at the report,arguing that it was based on old data, its methodology wasflawed, and it went against the global consensus, which is infavour of screening.“Like numerous national and international experts andorganisations (WHO, EU), the Cancer League believes that thepros outweigh the cons,” the organisation said in a statement.Swiss Cancer Screening said that the report used exactly thesame data that have led respected experts worldwide to reach

the opposite conclusion. It criticised the board for questionablemethodology, overemphasis on certain studies, and inaccuratecalculations.In 2013 Switzerland adopted a national strategy against cancer,recommending systematic screening for women over 50. Elevenof the country’s 26 cantons have put screening programmes inplace, some only within the last year. The Federal Public HealthOffice said it saw no reason to change that strategy but, it said,every effort must be made to improve the quality ofmammography screening.Debate has grown in recent years over the benefits anddisadvantages of breast cancer screening. The BMJ publisheda large Canadian study on 11 February, based on more recentdata, that drew similar conclusions to those of the SwissMedicalBoard.2

In the UK, the parliamentary Science and TechnologyCommittee is reviewing the evidence underpinning all nationalscreening programmes and is accepting submissions for thereview up to 26 February.3

The Netherlands recently reviewed its screening programmeand concluded, on 26 January, that the “advantages [ofmammography 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 breastcancer 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

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BMJ 2014;348:g1625 doi: 10.1136/bmj.g1625 (Published 18 February 2014) Page 1 of 1

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