The issue of whether screening mammography helps reduce the mortality level from breast cancer continues to be debated. The most recent controversy surfaced when the results of the same scientific study were interpreted by different sets of scientists and published in two widely read journals.
One group contends screening mammography does little, if anything, to reduce the death rate from breast cancer, whereas the other group maintains that screening mammography has had a significant impact on lowering the number of women who die of breast cancer each year. According to those in the screening/early detection community, the media have reported on the controversy with a heavily negative bias.
The result? Confusion for women as to the value of undergoing screening mammograms.
Among the many articles, news releases, editorials and letters that have been generated over the past few weeks, here is what the Komen Foundation had to say …
The Susan G. Komen Breast Cancer Foundation continues to recommend annual screening mammography for all women 40 years of age and older. If a woman has a family history of breast cancer or fits other 'high risk' criteria, she should seek her physician's counsel in whether to begin yearly screening at an earlier age. In the United States, it is estimated that 192,000 women and 1,500 men will be diagnosed with breast cancer this year. Approximately 40,200 women and 400 men will die of breast cancer.
Today, as a result of screening mammography more women are being diagnosed at earlier stages when there are more treatment options and a greater chance of surviving the disease. Stage 1 and 2 breast cancers make up 67% of all breast cancers diagnosed in Caucasian women in the United States and 61% of those found in Black women. Since the early 1990s the mortality rate from breast cancer has been decreasing by 2% a year. This can be attributed to use of screening mammography, early detection and therefore more timely access to better, more targeted treatments.
Here is an overview of the recent controversy:
The British journal Lancet published a meta-analysis performed by two Danish researchers, Gotzche and Olsen, that looked at several major randomized trials of screening mammography. The authors concluded that "there is no reliable evidence that screening for breast cancer reduces mortality."
This month, the Cochrane Library published a version of the Gotzche and Olsen paper that had been reviewed by the Cochrane Breast Cancer Review Group Editors. This paper concluded that, "If data from all eligible trials are considered, then the relative risk for breast cancer mortality after 13 years is 0.80 (95% CI 0.71-0.89)." This is a 20% reduction in breast cancer mortality due to mammographic screening.
The Susan G. Komen Breast Cancer Foundation as well as researchers and physicians working within the breast cancer screening community maintain that mammography plays a critically important role in detecting malignancies that are not clinically apparent (occult). These cancers are generally smaller, lower grade, not spread to the lymph nodes and easier to treat that the typically more advanced disease detected clinically. Many occult breast cancers, if left untreated, will progress to advanced stages with metastasis and subsequent death.
A physician/advisor to the Komen Foundation said it this way: "We believe that not at least offering [women] a method to search for occult breast malignancy is unethical." Calling the recent controversy an "argument of abstraction on paper," this physician added, "I will continue recommending screening mammography, because it works in the real world."
(Additional note: The Johns Hopkins Breast Center continues to encourage women, beginning at age 40, to have annual mammograms.)
SOURCE:
The Susan G. Komen Breast Cancer Foundation (http://www.komen.org)
