Intuitively, and by conventional wisdom, the detection of a tumour when it is small should lead to better outcomes and survival rates ("Fighting breast cancer with better knowledge"; Sept 28).

Yet, mammograms which pick up smaller and clinically non-palpable cancer tumours are also responsible for many unnecessary operations and unwarranted mental anguish.

The New England Journal of Medicine recently reported that mammograms are significantly overestimated as a life-saving tool.

There is now better and wider recognition that a tumour's genetic make-up and tumour-host interaction are better predictors of tumour aggression than its mere size.

Data from the United States National Cancer Institute also suggests that in about 80 per cent of women, small, anomalous breast lumps picked up by mammograms would likely not be life threatening, even if left untreated.

As physicians, we want to be proactive and nip diseases in the bud.

Better forms of treatment for tumours have increased the lifespan of breast cancer sufferers.

Yet, too much unnecessary expensive and painful treatment has also been effected by abnormal mammograms when tumours did not need to be treated. This could have resulted in fallaciously good survival statistics.

Perhaps the health authorities should look further into working out a better algorithm for breast cancer screening using mammograms and its subsequent management.

With medical insurance premiums set to rise, whatever is superfluous and empirically unproven needs further consideration before continued adoption ("Health insurance premiums set to shoot up"; Sunday).

Yik Keng Yeong (Dr)