February 6, 2002 Circling the Mammography Wagons As the debate over the value of mammography intensifies, it is disappointing that key organizations and individuals in the cancer establishment have mostly chosen to draw their wagons in a defensive circle. Now that recent studies have raised serious challenges to the value of mammograms, other experts need to examine the data with an open mind if the public is to retain its faith in the recommendations of prestigious medical organizations. The prevailing orthodoxy on breast cancer is based on seven major studies that found mammograms can help save women by detecting tumors early, when they are most treatable. That conventional wisdom was challenged by two researchers in Denmark, who concluded that five of the seven studies were too flawed to warrant much confidence, and that the other two studies taken in combination showed no evidence that mammography reduced breast cancer deaths or prolonged women's lives. That conclusion was endorsed by the editor of The Lancet, a respected British medical journal, and by an expert group sponsored by the National Cancer Institute whose job is to update the cancer information supplied to doctors and patients. This state of affairs can only be described as astonishing. For many years mammography has been a bedrock of efforts to reduce the toll from breast cancer, yet now a handful of respected scientists are suggesting that it may all have been a huge mistake, a misreading of the clinical trials that were supposed to determine whether mammography helped save lives or did not. It's not surprising that the cancer establishment, which has devoted so much effort to persuading women to have mammograms, is unsettled. Its reaction has been to call on higher authority — itself. In a full-page ad in The Times last Thursday, 10 health organizations asserted that despite some flaws in the studies, "the evidence as a whole" solidly supports the idea that breast cancer mortality rates are reduced by screening mammography. The statement derived its authority from the prestige of the signers, which include the American Cancer Society, the American Medical Association and the American College of Obstetricians and Gynecologists, among others. A more technical defense was mounted by scientists at McGill University and the Weill Cornell Medical College who published a research letter last week rebutting the critics. But as a defense of mammography, the paper fell far short of inspiring confidence. The authors relied on a single study that focused on a narrow range of years after the initial screening. Meanwhile, a paper published today by scientists at Dartmouth Medical School seemed to support the mammography critics. It suggests that efforts to assign a cause of death to any particular cancer are often biased in favor of screening, as critics of mammography have contended. At this point, with the debate still unsettled, it seems foolish for women who have been undergoing regular mammography screenings to abandon their routines. But a serious and open reassessment of the data is crucial, and it must be conducted by an organization that can be trusted for its objectivity. The most credible organization to re-evaluate mammography might be the National Cancer Institute, which in some past controversies has shown independence of the cancer organizations, or perhaps the National Academy of Sciences, which is explicitly designed to perform independent reviews of controversial issues. New York Times 2/06/02 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.