British Mammography Claim Angers American Clinicians

The Lancet Claims That X-ray Mammography is not Effective in Detecting Breast Cancer or in Saving Lives

IMS Observations    
Multiple studies indicate that cancer caught in earlier stages results in better outcomes because there are more treatment options available.  It is hard to understand why The Lancet would publish an article that indicates that earlier detection using X-Ray mammography versus Self Breast Exam is not effective in saving lives. In fact we would suggest that finding breast cancer even earlier than X-Ray Mammography using Infrared Mammography results in even better outcomes.  Infrared Mammography is able to find breast cancer 8 years earlier than X-Ray Mammography because of the way it screens for the disease.  We encourage you to learn more about Infrared Mammography and make it part of your personal breast health program.


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By Kelley Devereaux
Lancet mammography piece gets worldwide attention

In December, the British journal The Lancet published the writings of two researchers which claimed that mammography is not effective in detecting breast cancer or in saving lives. Mammography experts in the United States are calling it a terrible case of journalistic sensationalism, but the authors stand by their claims.

The background is this-a 1999 study found no decrease in breast-cancer mortality in Sweden, where screening has been recommended since 1985. The authors therefore reviewed the methodological quality of the mammography trials and an influential Swedish meta-analysis, and did a meta-analysis themselves.

From this, Olsen and Gotzsche concluded that screening for breast cancer with mammography is unjustified. They said, if the Swedish trials are judged to be unbiased, the data show that for every 1000 women screened biennially throughout 12 years, one breast-cancer death is avoided whereas the total number of deaths is increased by six and that if the Swedish trials (apart from the Malm trial) are judged to be biased, there is no reliable evidence that screening decreases breast-cancer mortality.

In essence, they said there is no evidence that breast-cancer screening with mammography saves women's lives.

That 1999 report was highly criticized. The National Center for Policy Analysis (NCPA) subsequently reported that researchers in Copenhagen re-analyzed their data according to the protocol of the Cochrane Collaboration, an international organization that has established rigorous standards for conducting and publishing research reviews. Their conclusion about mammography remains the same: the studies that have indicated mammography saves women's lives by catching breast cancer early employed flawed methods.

But public health experts in the United States say this re-analysis doesn't refute the criticisms that have been lobbed at the Danish researchers. The American College of Physicians still recommends that women get a mammogram every year starting at age 40. Breast cancer death rates have declined in the U.S. and U.K. in the 1990s. While better cancer treatment certainly contributed to this decline, experts say early detection made a significant difference.

"The issues raised have been reviewed for decades," Daniel Kopans, MD, professor of radiology at Harvard Medical School in Boston, wrote to the Lancet. "The majority of World experts agree that women can benefit from mammographic screening. It is unclear why the Lancet would publish the summary of such a poorly performed review, where the data analysis that it references is not even available, at a time when the benefits of mammography have not only been clearly shown in randomized, controlled trials, but have also been shown in the general population."

Canadian Study Has Holes, Too ?Teaching women get regular mammograms is part of the lexicon of the American health system. To imagine teaching the contrary seems ludicrous.

Yet, this claim published in the Lancet is not the first of its kind to set off American radiologists.

The Canadian Task Force on Preventive Health Care published a study in the June 26 edition of the Canadian Medical Association Journal (CMJ), asserting that women between the ages of 40 and 69 should not routinely be taught to do breast self exam (BSE) because there is no clear link that shows BSE to prevent deaths from cancer.

In the study, author Nancy Baxter, of the University of Toronto, explains, "To date, two large, randomized controlled trials, a quasi-randomized trial, a large cohort study and several case-control studies have failed to show a benefit for regular performance of BSE or BSE education, compared with no BSE. In contrast, there is good evidence of harm from BSE instruction, including significant increases in the number of physician visits for the evaluation of benign breast lesions and significantly higher rates of benign biopsy results."

In this case, the authors consider anxiety caused by finding a lump to be harm. While it's true, women who find a lump may experience unnecessary anxiety if they later discover it's benign, it's a level of harm most radiologic professionals in the United States consider tolerable.

Dr. Kopans took offense at that claim, too. He explained, "On the surface, the authors of the review are correct. There are no randomized controlled trials (RCT) of BSE that show it reduces the death rate from breast cancer." Dr. Kopans said that there are only two known trials of BSE. One took place in the former Soviet Union and one in China. Neither provided statistically significant results. He added, "The benefit from screening may take many more years to demonstrate since early detection of moderate to slow growing tumors will not show up for many years, so that it is too early to say that it does not provide a benefit."

The bottom line, say American practitioners, is to stick to the tried and true practices of mammographic screening and BSE. No real evidence suggests doing anything less.


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