To Screen or Not to Screen? Ethical Reflections on the Current Controversy about Mammography Screening

Mammography screening has become a popularpublic health intervention. However, the benefit ofsystematic population screening programs iscontroversial. This raises a number of ethical issues:How should disadvantages of screening – inparticular overdiagnosis – be weighed against itspotential benefits? What do women need to know inorder to make an informed decision for or againstscreening? Should scarce public resources beinvested in a program with unclear effectiveness?The following brief contribution will discuss theseissues, comment on the recent policy debate inSwitzerland, and suggest some points for furtherconsideration.Mammography screening has become a popularpublic health intervention. According to figures ofthe International Agency for Research on Cancer(IARC), the specialized cancer agency of theWorldHealth Organization, breast cancer is the mostfrequently diagnosed cancer among womenworldwide. In ۲۰۱۲, ۵۲۲۰۰۰ women worldwide diedfrom breast cancer, and ۱.۷ million women werenewly diagnosed that year.۱So breast cancer is both a serious challenge,sometimes a tragedy for individual patients and theirfamilies, and an important public health challenge.There is no doubt that reducing the breast cancerburden is an ethical imperative. It seems that oneway to go would be to focus on early diagnosis,which would lead to more gentle yet effectivetreatment, which would again save lives or at leastsome quality of life.