Mammography wars

Latest article ignites fire

When my husband and I had dinner with my father Saturday night, my father asked what I thought about the latest mammography report. The Canadian study, which ignited the latest firestorm after 25-year results were published recently in the British Medical Journal, was a carefully conducted trial with long-term data. The report found no statistically significant decrease in death rates among the studied groups, i.e., there was no significant benefit of mammography above that of breast exams performed by carefully trained nurses.

My father said he thought it was terrible to confuse women by undermining mammography. As vice president for information at the American Cancer Society for more than 25 years, he’d steadfastly promoted the benefits of screening tests, including mammography. I was encouraged that my 92-year-old father still could feel so passionately about an issue. I told him that simplicity of message may be great for communicators, but it is not always good science. The report’s methods have been undermined and attacked by those who want to believe that mammography can’t be bad if it finds abnormalities. However, finding abnormalities that aren’t cancer, as Gilbert Welch and others have pointed out, can have many downstream effects.

I’ve been on both sides of the issue. In 1997, I was part of a panel, chaired by Dr. Suzanne Fletcher, whose members reported there was insufficient evidence to recommend routine mammography for women in their 40s. Later, I was chair of the National Cancer Advisory Board when many of the international trials had matured, and there was sufficient evidence to recommend mammography for women in their 40s.

However, we placed a strong emphasis on women making informed decisions, knowing the risks and potential benefits of screening. I’m not an evangelist for or against mammography or any other any medical test — but show me the evidence. The Canadian trial was well done and did not find that mammography reduced death rates more than well-performed clinical breast exams. That’s the evidence. Women and their doctors should talk about these things, and then women should decide what to do for themselves.

As I told my father, women should know the truth. It’s deceptive to tell women that tests are better than they are just to make the message clearer and simpler. Talk with the people in your lives about these issues. They’re important.

Happy Monday. Barbara