The overestimation and the inappropriate promotion of the benefits of mammographic screening in breast cancer research and interventions in the Gaza Strip

Abstract Background There has been extensive debate about whether mammographic screening has done more good than harm. Recent reviews showed that women who undergo mammographic screening are more likely to have a tumour that was an overdiagnosis and therefore would not cause them problems. In the Gaza Strip, a strong forum of people advocate an increase in mammographic screening, and the aim of this study was to establish the evidence for this view. Methods Research papers that have focused on breast screening in the Gaza Strip or elsewhere in the occupied Palestinian territory were reviewed. Published educational material, including brochures, booklets, and short videos on mammographic screening, were also reviewed. A thematic analysis was done to document the opinions of authors on the effect of mammography. Findings 11 studies and 20 sets of educational material were identified. Results of six cross-sectional studies showed that about 70% of Palestinian women had never had a mammogram, whereas data from one study showed that 90% of women in the Gaza Strip were willing to undergo diagnostic mammography, but around 30% of them were willing to undergo mammographic screening. Some investigators argued that mammographic screening programmes would improve survival by more than 20% in the Gaza Strip. The authors of two retrospective cohort studies concluded that Palestinian women have low survival rates because of the poor availability of mammography. Only three study groups mentioned harmful effects of mammographic screening. All educational materials had clear information on the benefits of mammographic screening but minimal information on its harms. Interpretation Research in the Gaza Strip overestimated the reduction in breast cancer mortality that can be attributable to mammographic screening, and this would encourage women to undergo screening without knowing that it could harm them. The content of breast cancer educational material was misleading. This study shows that the information and advice given to women in the Gaza Strip is one-sided. Funding None.