Mammography is Unjustified--A Letter Few Newspapers Will Print
The following is an editorial
I sent to over a dozen major US newspapers and so far I know of only one
to print it (the Honolulu Advertiser). You may want to submit this letter
to your newspaper. At the end of this article you will find the links to
the original papers cited so you can read and come to your own
conclusions.
Mammography is Unjustified
The Cochrane review1
on screening mammography and an accompanying editorial2
published in the October 20, 2001 issue of the Lancet have created
an emotionally charged stir in the medical business and many responses to
try to control the damage. (See �Playing with Women�s Lives� by Spyros
Andreopoulos in the Wednesday 12/19/01 San Francisco Chronicle and
�Changing Medical Advice� in Wednesday 12/26/01 San Francisco Chronicle).
A systematic review of the randomized trials of mammography by the highly
respected Nordic Cochrane Center came to the conclusion �that there is no
reliable evidence that screening for breast cancer reduces mortality,�
and �that screening leads to more aggressive treatment.� Many other
highly respected researchers have come to similar conclusions. In 1995
Dr. Charles Wright, Clinical Professor, Department of Health Care and
Epidemiology at the University of British Columbia, reported in the
Lancet3 his conclusions after
reviewing the data: �Since the benefit achieved is marginal, the harm
caused is substantial, and the costs incurred are enormous, we suggest
that public funding for breast cancer screening in any age group is not
justifiable.�
Prior to this, writing in a 1989
edition of the British Medical Journal, M. Maureen Roberts,4
clinical director of the Edinburgh Breast Cancer Screening Project since
1979, stated that, "We can no longer ignore the possibility that screening
may not reduce the mortality in women of any age, however disappointing
this may be ... I believe that a rethink is required before the programme
goes any further. I feel sad to be writing this; sad because naturally
after so many years I am sorry that breast cancer screening may not be
beneficial, I am also sad to seem to be critical of the many dear and
valued colleagues I've worked with over the years, particularly those who
have made such a magnificent contribution to the care and welfare of women
with breast cancer. But they will recognize that I am telling the
truth." Ms. Roberts' article was published posthumously after her death
from breast cancer.
The reason mammography fails is
because it is a crude technique that most often finds the cancer in the
breast only after it has been growing there for 8 to 12 years. By this
time, if it is truly cancer, it has spread to other parts of the body,
beyond the reach of surgery and/or radiation. Unfortunately, our methods
of dealing with disease that has spread � chemotherapy and hormone therapy
� are of limited benefit.
Beyond the billions of health
care dollars fruitlessly spent, what are the real harms to a woman from
mammography? Fear and anxiety surrounding this test take a toll on her
daily life. Once an abnormality is found on a mammogram she will likely
have surgery. In eight out of ten cases the lump is not cancer � so
surgery was unnecessary. If she is diagnosed with cancer her whole world
changes: she can no longer get life or health insurance, a career may no
longer be available, and now everyone worries about �the breast cancer
victim.� Furthermore, if the tests and treatments really do add little to
a woman�s chance of surviving, then think of all the unnecessary costs,
pain, and suffering caused by surgery, radiation, and chemotherapy -- and
all the disappointment that follows false hope.
The burden of proof lies with
those who recommend tests and treatments. If you believe that the
Cochrane review, Charles Wright, Maureen Roberts and many other respected
researchers are correct in their position that �screening for breast
cancer with mammography is unjustified,� then it is way past the time when
we should have brought this universal medical practice in line with the
scientific evidence. Unfortunately, I believe politics, pride, fear of
medical malpractice suits and billions of lost dollars will allow this
behemoth to continue to trample over the health and welfare of women.
Finally, for my colleagues I paraphrase Maureen Roberts, �But you will
recognize that I am telling the truth.�
John McDougall, MD
Author of the McDougall Program for Women
drmcdougall@drmcdougall.com
707-576-1654
PO Box 14039
Santa Rosa, CA 95402
References to the above:
1. Olsen O, Gotzsche P. Cochrane review on screening for breast cancer
with mammography. Lancet 358:1340-2, 2001.
2. Horton R. Screening
mammography -- an overview revisited. Lancet 358:1284-85, 2001.
3. Wright C. Screening
mammography and public health policy: the need for perspective. Lancet
346:29, 1995.
4. Roberts M. Breast
screening: time for a rethink? BMJ 299:1153, 1989.
[End here when sending to your
newspaper]
The Cochrane report has sent
shock waves through the nation, especially for women and the medical
business. And the pillars supporting mammography (and of all early
detection screening programs) are starting to crumble. Most recently an
independent panel of medical experts which writes information for the
National Cancer Institute has concluded that there is insufficient
evidence to show that mammography prevents death from breast cancer.5
Unfortunately, the media are not playing fair. A recent study on
�Newspaper reporting of screening mammography,� in the Annals of
Internal Medicine found that newspapers over-represent support by 2 to
1 for screening mammography at the highly controversial ages of 40 to 49
years.6 Maybe you can counteract some of
this biased reporting, by getting your local paper to print my letter. I
encourage you to read the Cochrane report from the Lancet, the
accompanying editorial, the news from the medical experts and the
responses to these articles (see below for all the links).
Those of you interested in the
subject will find a thorough discussion of mammography in the book The
McDougall Program for Women. You will also learn why you should put
your efforts into a healthful diet and lifestyle in order to prevent
breast cancer.
5. Charatan F. News--US panel
finds insufficient evidence to support mammography. BMJ;324:255.
2002.
6. Wells J. Newspaper reporting
of screening mammography. Ann Intern Med 135:1029-37, 2001.
Links to above:
The Report:
http://thelancet.com/journal/vol358/iss9290/full/llan.358.9290.original_research.18001.1
Medical Expert Panel for the
National Cancer Institute:
http://bmj.com/cgi/content/full/324/7332/255
The Editorial:
http://thelancet.com/journal/vol358/iss9290/full/llan.358.9290.editorial_and_review.18003.1
Electronic Letters:
http://bmj.com/cgi/eletters/323/7319/956
�Playing with Women�s Lives� by
Spyros Andreopoulos in the Wednesday 12/19/01 San Francisco Chronicle
http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2001/12/19/ED147120.DTL
�Changing medical advice� in
Wednesday 12/26/01 San Francisco Chronicle
http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2001/12/26/ED144228.DTL. |