Strong Beliefs and Soft Evidence Underlying Mammography Surveillance Recommendations in Breast Cancer Survivors: A Study in Reflexive Science and Decision-Making

Abstract

Breast cancer is the most common cancer in women worldwide and more recently it has overtaken lung cancer as the world’s mostly commonly-diagnosed cancer, according to statistics released by the International Agency for Research on Cancer (IARC) in December 2020 Mammograph screening has been widely used as screening modality and been shown in reduce mortality. Although, benefit of screening mammography in healthy woman cannot be denied, extrapolating this evidence from screening experience in healthy individuals may be unrepresentative and erroneous. Continued mammographic surveillance of breast cancer survivors (BCSS) as of now continued to be standard of care even though still an unsettled issue in survivorship care due to the absence of high-level evidence supporting this current practice. Besides the fact that data regarding efficacy of mammography in BCSS is unclear, there are other concerns regarding its use. Considering, mammography is associated with false positive results requiring additional evaluations, overdiagnosis leading to needless treatment, psychological distress, physical discomfort and significant health-care expenditure, understanding the risk-benefit ratio of mammography in BCSS is crucial. Appropriate studies evaluating mammographic surveillance in BCSS are necessary to assess survival outcomes, costbenefit ratios and to identify subgroups that derive significant benefit. This holds the key to avoiding unwanted harm to our patients as well as unnecessary financial burden on health-care services.