The importance of internal dissent in the sciences: the case of mammography screening for breast cancer

Abstract

Internal dissent within the sciences is important for changes and course corrections in the sociotechnical development of health-disease care. This work discusses the recommendation of breast cancer screening as a case of internal dissent in biomedicine, which deserves the application of quaternary prevention (P4): action to protect people from iatrogenic damage and overmedicalization. Based on a critical narrative review of the main aspects involved in the scientific controversy over this screening, we argue that there is growing evidence making its benefit-harm balance at least doubtful, if not negative, due to the dimension of the greatest damage (overdiagnosis and overtreatment) and the reduction of the estimated benefits, until its nullity. Such dissent has been clouded by official recommendations, biased reports, economic and corporate interests, illusory beliefs, fictitious expectations, and the popularity paradox. We argue that P4 in this case means suspending or reversing the positive recommendation for periodic mammography. This means a great institutional, social and political challenge, in the current context of preventivism and moral/emotional appeal associated. This theme is an example of the need to explore the internal dissent in the sciences as a means of critically improving disseminated preventive biomedical practices and reducing inequalities in health.