The Cost-effectiveness of Breast Cancer Screening

In a moving, reflective survey of the science, politics, and ethics of screening for breast cancer, which was published posthumously, Maureen Roberts asked: "Are we brainwashing ourselves into thinking that we are making a dramatic impact on a serious disease before we brainwash the public?" (2). Such bluntness is unusual in medical journals, particularly when "brainwashing" refers to a widely acclaimed preventive measure that is believed to prevent thousands of women from dying a miserable death. What is unique in this account is that it was written by the clinical director of the Edinburgh Breast Cancer Project and the main organizer of the Edinburgh randomized controlled trial of screening mammography. "We all know," she wrote, "that mammography is an unsuitable screening test: it is technologically difficult to perform, the pictures are difficult to interpret, it has a high false-positive rate, and we don't know how often to carry it out. We can no longer ignore the possibility that screening may not reduce mortality in women of any age, however disappointing this may be" (2).