Screening for breast cancer with mammography
Authors: Hazel Thornton
Journal: The Lancet (2001)

Predictably, Ole Olsen and Peter GØtzsche's conclusion1Olsen O GØtzsche PC Cochrane review on screening for breast cancer with mammography.Lancet. 2001; 358: 1340-1342Summary Full Text Full Text PDF PubMed Scopus (615) Google Scholar that mammographic screening is of uncertain benefit and leads to greater use of more aggressive treatment and other harms, has provoked adverse criticism from many who believe that screening saves lives. Richard Horton, in his Commentary,2Horton R Screening mammography–an overview revisited.Lancet. 2001; 358: 1284-1285Summary Full Text Full Text PDF PubMed Scopus (70) Google Scholar and the alternative version of the report on the journal's internet site3Olsen O GØtzsche PC Cochrane review on screening for breast cancer with mammography.http://image.thelancet.com/lancet/extra/fullreport.pdfGoogle Scholar have exposed disagreement among the editorial ranks of the people responsible for producing Cochrane systematic reviews of evidence for breast cancer: this is a problem of serious import.The new elements in this latest review that confirm and strengthen Olsen and GØtzsche's previous findings, rest on their statement that breast cancer mortality is a misleading outcome measure. It is occasioned by their findings that mammographic screening leads to greater use of more aggressive treatment, increases the number of mastectomies by about 20%, and inflicts important psychological distress on more than 10% of the healthy population who attend screening programmes, evidenced in a cited systematic review.These arguments have been in the public domain for some time,4Thornton H Randomised clinical trials: the patient's point of view.in: Silverstein M Ductal carcinoma in situ of the breast. Lippincott, Williams and Wilkins, Philadelphia1997Google Scholar but are largely dismissed as irrelevant by workers zealously pursuing the goal of reduction of mortality from breast cancer, without regard for the risks, limitations, and consequences, to women invited for screening but not informed about the risk of the procedure or of receiving a diagnosis of ductal carcinoma in situ.Olsen and GØtzsche point out that mass screening involves the entire population and may cause a screening associated increase in mortality, as well as other harms.Attempts by the Cochrane Breast Cancer Review Group to suppress these features, by insistence on changes to the review as a condition of its publication in the Cochrane Library, are a blatant threat to the over-riding principle of freedom of appointed investigators to place all legitimate findings in the public domain without judgmental interference.Such threats to integrity must not be allowed to go unchallenged. Attempts to muzzle unpopular findings, if successful, would undermine trust in research processes and methods to the harm of the general welfare of society and progress in health care. The gatekeeping function of medical journalism has again been put to the test.5Davidoff F DeeAnglis CD Jaffrey M et al.Sponsorship, authorship, and accountability.Lancet. 2001; 358: 854-856Summary Full Text Full Text PDF PubMed Scopus (137) Google Scholar Preservation of freedom of speech is essential so that careful reflection and proper discussion may follow, because the implications for women and policy makers are substantial.2Horton R Screening mammography–an overview revisited.Lancet. 2001; 358: 1284-1285Summary Full Text Full Text PDF PubMed Scopus (70) Google Scholar Predictably, Ole Olsen and Peter GØtzsche's conclusion1Olsen O GØtzsche PC Cochrane review on screening for breast cancer with mammography.Lancet. 2001; 358: 1340-1342Summary Full Text Full Text PDF PubMed Scopus (615) Google Scholar that mammographic screening is of uncertain benefit and leads to greater use of more aggressive treatment and other harms, has provoked adverse criticism from many who believe that screening saves lives. Richard Horton, in his Commentary,2Horton R Screening mammography–an overview revisited.Lancet. 2001; 358: 1284-1285Summary Full Text Full Text PDF PubMed Scopus (70) Google Scholar and the alternative version of the report on the journal's internet site3Olsen O GØtzsche PC Cochrane review on screening for breast cancer with mammography.http://image.thelancet.com/lancet/extra/fullreport.pdfGoogle Scholar have exposed disagreement among the editorial ranks of the people responsible for producing Cochrane systematic reviews of evidence for breast cancer: this is a problem of serious import. The new elements in this latest review that confirm and strengthen Olsen and GØtzsche's previous findings, rest on their statement that breast cancer mortality is a misleading outcome measure. It is occasioned by their findings that mammographic screening leads to greater use of more aggressive treatment, increases the number of mastectomies by about 20%, and inflicts important psychological distress on more than 10% of the healthy population who attend screening programmes, evidenced in a cited systematic review. These arguments have been in the public domain for some time,4Thornton H Randomised clinical trials: the patient's point of view.in: Silverstein M Ductal carcinoma in situ of the breast. Lippincott, Williams and Wilkins, Philadelphia1997Google Scholar but are largely dismissed as irrelevant by workers zealously pursuing the goal of reduction of mortality from breast cancer, without regard for the risks, limitations, and consequences, to women invited for screening but not informed about the risk of the procedure or of receiving a diagnosis of ductal carcinoma in situ. Olsen and GØtzsche point out that mass screening involves the entire population and may cause a screening associated increase in mortality, as well as other harms. Attempts by the Cochrane Breast Cancer Review Group to suppress these features, by insistence on changes to the review as a condition of its publication in the Cochrane Library, are a blatant threat to the over-riding principle of freedom of appointed investigators to place all legitimate findings in the public domain without judgmental interference. Such threats to integrity must not be allowed to go unchallenged. Attempts to muzzle unpopular findings, if successful, would undermine trust in research processes and methods to the harm of the general welfare of society and progress in health care. The gatekeeping function of medical journalism has again been put to the test.5Davidoff F DeeAnglis CD Jaffrey M et al.Sponsorship, authorship, and accountability.Lancet. 2001; 358: 854-856Summary Full Text Full Text PDF PubMed Scopus (137) Google Scholar Preservation of freedom of speech is essential so that careful reflection and proper discussion may follow, because the implications for women and policy makers are substantial.2Horton R Screening mammography–an overview revisited.Lancet. 2001; 358: 1284-1285Summary Full Text Full Text PDF PubMed Scopus (70) Google Scholar Screening for breast cancer with mammographyAuthor's reply Full-Text PDF