Should Routine Screening by Mammography be Replaced by a More Selective Service of Risk Assessment/Risk Management?

The NHS screening program was launched 20 years ago and, until recently, has been accepted in an uncritical way. However, emerging data have suggested that the reduction in breast cancer mortality owing to screening is much less than it has been credited for. Furthermore, the harms from false-positive results and the overdiagnosis of indolent disease, which includes the detection of a cancer that is not destined to present clinically in that patient's lifetime, are now perceived as much greater than ever anticipated. This article suggests that it is complacent to continue with the program unchecked, a program that has so far denied women an informed choice. It is also suggested that a more efficient use of scarce resources that may reduce all-cause mortality might be to shift from a ‘one size fits all’ approach, to a risk assessment/risk management scheme.