New York Times Examines ‘Bitter and Unusually Public’ Debate Over Mammograms
The New York Times yesterday examined the "bitter and unusually public" debate over the effectiveness of mammography at reducing breast cancer deaths, long considered "an article of medical faith." The debate, which is being "fought in the pages of medical journals and columns of daily newspapers," centers on whether women in their 40s should "still get that annual mammogram." Mammography critics say that the clinical trials "most often cited to support mammogram recommendations were too flawed to be reliable." Danish researchers Drs. Peter Gotzsche and Ole Olsen published a "dee[p] analysis" in October 2001 of seven large clinic trials on mammography, saying researchers in those studies included "potentially inaccurate records of causes of death, differences in screening schedules and possible discrepancies in the health histories of women in one of the trials." Based on that analysis, the P.D.Q. screening and prevention editorial board, an independent panel of experts that regularly assesses cancer evidence and writes material for the National Cancer Institute's online database, said it could no longer recommend that women get mammograms. For its part, the NCI has gone back and forth on its mammogram recommendations. Most recently, the institute said that the new analysis did "not refute evidence that mammography works," and the institute will continue to recommend that women ages 40 and older be screened. Dr. Steven Woolf, a member of the United States Prevention Services Task Force, which reviews scientific evidence about disease prevention, said, "I think the trials have imperfections. But the issue is whether they invalidate the studies. My own view is that they do not rise to that level."
According to the Times, 20% of all breast cancer cases detected each year are diagnosed as D.C.I.S, or ductal carcinoma in situ, which mammograms are "especially good" at locating. However, "many if not most of these growths ... might never spread," leaving the approximately 30 million women who have mammograms each year running the risk of receiving "unnecessary and dangerous treatment: radiation, chemotherapy, surgery." The Times reports that "too little is known about breast cancer biology to determine which [growths] will pose a threat." As the debate over mammography continues, the Times reports that a "new trial would require tens of thousands of women and a decade for results," prompting some researchers to call for "deeper and more carefu[l]" investigation into existing data. Some researchers say that the Danish team "raised alarming questions without offering evidence that the results were actually skewed" and are calling for an independent committee to "review the original data from all the trials" to answer the questions raised by the Danish studies. In the meantime, Dr. Lynn Hartmann, a Mayo Clinic breast cancer specialist, said, "I am not at the point of saying we should discard this tool. Until we have a more effective substitute, I continue to recommend mammograms, and I continue to have them" (Kolata/Moss, New York Times, 2/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.