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| The Mammogram Controversy | |
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The many American women who routinely have a mammogram were probably quite surprised to hear a recent report concluding that mammograms do not save lives. This low-dose X-ray exam has been part of preventive healthcare for many years because it finds breast cancer early, often years before a woman or her doctor could feel a lump. But even established procedures are reviewed in medicine, and debate is encouraged in the pursuit of truth. Two Danish researchers certainly started a debate with their analysis of the value of mammography, published in the British medical journal Lancet. The researchers analyzed seven large studies of mammography often used as evidence of the test's ability to save lives. They decided that most of the studies weren't designed well enough to give reliable answers and the two that were didn’t show any benefit. However, after an extensive review of the same published studies, the US Preventive Services Task Force recently concluded that screening can indeed reduce deaths from breast cancer. They recommended that women undergo screening mammography every one to two years beginning at age 40. But they noted that the evidence for a survival benefit is "strongest for women aged 50 to 69." Debate Reaches the National Institutes of Health
The Danish analysis ran against the widely accepted view that mammograms do save lives -- by finding breast cancer early when it is most easily treated and with the fewest side effects. It also triggered experts at the National Cancer Institute (NCI) to comment on the guidelines they issue about mammography. The New York Times and other media outlets made the controversy front-page news. NCI made no changes to its recommendations for screening mammograms. “The National Cancer Institute recommends mammography beginning at age 40 for women at normal risk of breast cancer,” said Peter Greenwald, MD, DrPH, director of screening and cancer prevention for the NCI. The American Medical Association and the American Cancer Society (ACS) also confirmed that mammograms save lives by finding breast cancer early. Mammograms are part of a three-step early detection program recommended by ACS. Robert Smith, PhD, director of cancer screening for the ACS, noted that finding tumors earlier and improvements in therapies to treat them have resulted in yearly declines in breast cancer deaths since 1990. Smith said the rate of decline has accelerated to 3.4% per year, up from 2% during the 1990s. New Evidence That Mammography Does the Job
More evidence that mammography saves lives comes from a newly published study of breast cancer deaths in Sweden before and after a mammography program was put in place. The authors, Stephen W. Duffy and colleagues, found deaths from breast cancer were reduced by 44% since the mammography program began. The full report can be found in the August 1, 2002 issue of the journal CANCER. One study is not enough to provide a final answer to a scientific question. But in an editorial also published in the same issue of CANCER, an independent expert said the new research adds to the body of evidence on the effectiveness of early breast cancer detection. Stephen A. Feig, MD, wrote that the report by Duffy and colleagues "effectively refutes the controversial claims made in the last year by two Danish researchers (Lancet, January 8, 2000; Lancet, October 20, 2001) that randomized clinical trial results which demonstrate reduced breast cancer mortality were not valid.” ________________________________________________ More Breast Cancer Awareness Month Special Features
This year, 203,500 American women will be diagnosed with breast cancer and 39,600 will die of the disease. (Men can also get the disease, but at far lower rates.) In addition to taking care of your own health and having regular early detection tests, there’s a lot you can do to fight this disease. For information call 1-800-ACS-2345. Published 09/27/02 |
