The study, published on the British Medical Journal website, has stirred controversy among experts and organizations concerned with breast cancer.
"Early screening means early detection, better treatment and definitely a better quality of life" says Al-Shahed who believes that some of the studies take into account the cost effectiveness of the screening rather than the actual benefits. She believes too that many studies admitting the importance of early screening in reducing deaths and providing less aggressive treatment.
While a 2005 study suggested that screening had reduced breast cancer deaths by 25 percent in Copenhagen, Karsten Jorgensen and Peter Gotzsche from the Nordic Cochrane Center in Copenhagen, together with Per-Henrik Zahl from Folkehelseinstituttet in Oslo, identified important problems in the study and decided to undertake a more comprehensive analysis of the data.
They compared annual changes in breast cancer deaths in two Danish regions offering publicly organized screening programs with nonscreened regions in the rest of Denmark. Their analysis covered 10 years after screening could have had an effect on breast cancer mortality. For a comparison, they also looked at the 10-year period before screening was introduced.
They drew the following conclusion: "Our results are similar to what has been observed in other countries with nationally organized programs. We believe it is time to question whether screening has delivered the promised effect on breast cancer mortality."
"Early screening provides us with a two-year advantage in detecting the possibility of breast cancer before it occurs," says Al-Shahed, clarifying that conservative treatment might be useless after two years, when aggressive and more severe procedures are.
Meanwhile the American Cancer Society (ACS) continues to stress the importance of finding breast cancer early, stating that screening, which refers to tests and exams used to find a disease in people who do not have any symptoms, aims at detecting breast cancer before any symptoms appear. Many American doctors say, "Early detection tests for breast cancer save many thousands of lives each year, and many more could be saved if more women and their health care providers took advantage of these tests." Following the ACS guidelines for the early detection of breast cancer improves the chances that breast cancer will be diagnosed at an early stage and treated successfully.
In the Kingdom, breast cancer accounts for 20 percent of the total cancer cases presented to hospitals. According to the Saudi Cancer Registry Reports, there are 800 cases of breast cancer annually.
Although the Kingdom has no screening program yet, says Al-Shahed, the guidelines are thus not clear about when the screening should take place. Forty and above are considered safe and cost effective internationally, she said, yet exceptions may require earlier examinations, especially when there is a family history of cancer.
On the other hand, Susan Greenstein, a member of the Professional Advisory Board (PAB) of the Breast Cancer Organization, says that screening is important for everyone, indicating that three-quarters of women who are found to have breast cancer have no risk factors and that a screening test attempts to find the disease before there are any symptoms.
