Mammography screening may not save lives. This is a one-sentence distillation of how the latest debate over mammograms has played out in the media over the last three months. But this is only half the story, as HealthFacts readers might recall (see 12/01 issue). The research that put mammography in the news once again had also found that mammography screening actually increases a woman’s chances of losing a breast. Worse, there was a slight increase in treatment-related deaths among younger women who had been screened. The findings came from an analysis of the best clinical trials, which was conducted by Dr. Peter C. Gotzsche and Ole Olsen of the Nordic Cochrane Center and published last October in the British journal, The Lancet. Last month, a National Cancer Institute editorial board, which oversees the information presented in the agency’s prestigious database (www.cancernet.gov), ruled that mammography’s lifesaving benefit is uncertain. This prompted ten medical organizations to take out a full-page ad in the New York Times, telling women not to stop having mammograms because their lifesaving benefit has been well established by other analyses of the same clinical trials. The American Cancer Society, a signer of the ad and sponsor of the hotline listed at the end, cannot be considered a dispassionate source of information on this topic. The ACS has been the most influential promoter of mammography screening for nearly three decades. The pro-mammography viewpoint in that New York Times ad was confirmed the next day in an analysis of one of the best clinical trials published as a research letter in The Lancet (2/1/02). The Center for Medical Consumers takes the position that as long as one team of researchers found considerable harm and uncertain benefit, the matter is not over. Arguably, the analysis conducted by Gotzsche and Olsen is far more in-depth and more thoroughly peer-reviewed than other analyses of the same trials. Their critics have judged the increased-mastectomy finding to be obsolete because mastectomy is no longer the only treatment for breast cancer. But Dr. Gotzsche counters that in some countries, mammography-detected carcinoma in situ is currently treated with breast removal in about one-third of all cases (Letters to The Lancet, 2/1/02). Screening creates customers. And mammography screening has become a particularly lucrative industry, generating considerable profits to radiologists in biopsies alone. Any industry as entrenched as this one is likely to fight tooth and nail against researchers who find evidence of harm. And organizations like the ACS would have to admit that their longstanding advice to women has been erroneous and possibly harmful. The need for an independent assessment prompted our open letter to Dr. Andrew C. Eschenbach, Director of the National Cancer Institute. Copies went to the media and to Senators Tom Harkin and Barbara Mikulski, who plan to hold hearings on the issue. Dear Dr. Eschenbach: Only an independent review of all relevant clinical trials can resolve the questions surrounding mammography screening. For the conclusions to be unbiased, there should be no mammographers among the reviewers, nor should there be any representatives of organizations that have already issued mammography screening guidelines or recommendations. The reviewers should be methodologists, epidemiologists, biostatisticians, and other specialists in clinical trial design. It is imperative that the National Cancer Institute answer the questions raised by the analysis conducted by Dr. Peter Gotzsche and Ole Olsen of the Nordic Cochrane Center: -Does mammography screening reduce the breast cancer death rate? If so, is the drop offset by an increase in the overall death rate? -Does screening lead to more drastic treatments? -Can an independent review be conducted without the cooperation of the Swedish trialists who have thus far refused to release their data? -Is there any benefit to finding ductal carcinoma in situ? The 13-year results of one trial-- the National Breast Screening Study of Canada--indicate the answer is no. Most cases of DCIS are treated as if they all have the potential to be invasive cancer; yet only a minority would have progressed had they been left undetected. Because of mammography screening, thousands of women each year are treated with breast removal or six weeks of radiation therapy for a cancer that never would have killed them. Women need answers, or they will not be able to make an informed decision whether to continue having mammograms. Center for Medical Consumers Maryann Napoli Center for Medical Consumers, Health Facts 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.