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Promotion of screening mammography questioned.

Article Excerpt
Investigators from the Nordic Cochrane Centre in Denmark published a research letter in The Lancet (October 20, 2001) about a new systematic analysis of randomized trials of screening mammography. Ole Olsen and Peter C. Gotzsche said that the analysis strengthened their previously reported conclusions that screening mammography has not been shown to decrease mortality and is unjustified. They wrote that they followed a Cochrane Collaboration review protocol--a protocol noted for rigor and quality--in carrying out their analysis. The investigators published their full review on the Web site of The Lancet.

Editors of the Cochrane Breast Cancer Group insisted on significant modifications to their review. According to the investigators, the version of the analysis that was published in The Cochrane Library did not reflect Cochrane standards as well as the version published by The Lancet. Richard Horton, editor of The Lancet, wrote that the Cochrane editors did not welcome Olsen and Gotzche's conclusions.

A storm of media coverage and controversy among breast cancer experts ensued. The screening and prevention editorial board of PDQ (Physician Data Query), which writes information summaries for the National Cancer Institute's online database, found Olsen and Gotzsche's review persuasive. The board said it would rewrite previous statements accordingly. [Kolata G. Expert panel cites doubts on mammogram's worth. The New York Times 1/24/01.] The board noted flaws in previous studies, the lack of evidence that mammography prolongs lives, and concern that mammograms lead to aggressive treatments for tumors that would not have threatened women's lives. The board also said that it was rational for women to decide to have mammograms or to decide not to have them.

On the other hand, a February 3rd letter to the editor of The New York Times from 19...

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