The debate over mammography screening has taken women on twisted path. At its birth, mammography was hailed as a lifesaving tool that would catch breast cancer early and save countless lives, with little questioning and little discussion of its limitations. But for the past several years, experts have begun to discuss those limitations far more openly, with many saying we have overstated mammography’s benefits. Some critics have been downright hostile, questioning whether mammography screening does any good at all. Which brings me to a comment this week that made some of us stop in our tracks but that, surprisingly, does not seem to be raising a lot of eyebrows.
When it comes to mammography screening, the American Cancer Society’s recommendations say that women need to know the whole story. While recommending routine screening beginning at age 40, we also say women be made aware of mammography’s limitations. A mammogram will miss some cancers, and it sometimes leads to follow up of findings that are not cancer, including biopsies.
Our Chief Medical Officer, Otis W. Brawley, M.D., has been widely quoted as calling for balance, most recently telling the New York Times’ Gina Kolata:
“Screening is always a double-edged sword…. We need to be more cautious in our advocacy of these screening tests.”
That balanced approach has won praise from Gary Schwitzer, a former medical journalist who keeps a close eye on health reporting.
And now the quote that made us stop and wonder. It appears in a medical journal press release promoting new guidelines published today from the Canadian Task Force on Preventive Health Care.
“The best method we have to reduce the risk of breast cancer is to stop the screening programs.”
The quote comes from one of breast cancer screening’s most provocative critics, Danish medical researcher Peter Gotzsche, who heads the Nordic Cochrane Center in Copenhagen. Dr. Gotzsche and his center were actually called out in a letter from 40 international experts that appeared in The Lancet on Saturday:
“Although the wider scientific community has long embraced the benefits of population-based breast screening, there seems to be an active anti-screening campaign orchestrated in part by members of the Nordic Cochrane Centre.”
The quote caught the eye of our blogger-in-chief, Dr. Len Lichtenfeld, who today posts a thoughtful and important piece that I highly recommend.
Caught in the middle of the debate are women who are hearing a range of voices from moderate to extreme. The American Cancer Society still thinks the best advice is to be aware of the limitations of mammography, and to begin screening at age 40. In addition, it’s very important women receive high quality mammography and good follow up, so that this imperfect test’s benefits are reaped while addressing as best we can its weaknesses.