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The BMJ Today: Mammography wars and other conflicts

11 Mar, 14 | by BMJ

TJackson_09Anyone who questions the value of breast screening programmes must still feel a bit like Galileo did when he championed heliocentrism. To many people, including parts of the medical establishment, it seems counterintuitive to suggest that mammography might not be that effective and could lead to overdiagnosis. The evidence might be building, but it still doesn’t cut it, they say. The latest piece of evidence was the BMJ paper by Anthony B Miller and colleagues, “Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial,” published exactly a month ago today. The authors concluded that annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available. Four weeks on and 43 rapid responses later (not to mention the international press coverage and discussion in the blogosphere), the controversy over the paper still rages. In the past 24 hours, the BMJ has posted a lengthy response from the authors to their critics. One just-posted response refers to the “emotion and good intentions” that the responder argues “can overcome a rational and courteous approach to the debate on breast screening.”

And a responder from Uruguay, where mammographic screening is compulsory for every female worker age 40-59, says: “If mammography screening had been a drug, it would have been withdrawn from the market.” That responder is citing Peter C Gøtzsche of the Nordic Cochrane centre, a longstanding critic of mammography screening programmes, who has published much of his work on breast screening in the BMJ (for example this research paper).

From mammography wars to real ones: today we publish the obituary of Fred Vivian Griffiths, a London general practitioner who flew Hurricanes and Spitfires in the second world war and who, remarkably, survived unscathed to undergo medical revalidation at the age of 90. Flight Lieutenant Griffiths “flew 44 sorties in Hurricanes over north west Europe, and then transferred to reconnaissance Spitfires, making 66 sorties over Japanese occupied Burma,” writes his obituarist, Janet Fricker.

Trevor Jackson is a deputy editor, BMJ.

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  • David A L Morgan

    At the end of the day, rational scientific arguments do not always win out: even if the case against mammography were very much more scientifically robust than it is, it is almost inconceivable that any politicians would abolish screening programmes! Screening mammography is here to stay, whatever the course of the “mammography wars”. But in the, more serious, “war against cancer”, many women with screen-detected lesions become the “collateral damage”. These women undergo surgery, radiotherapy and drug treatment for a disease that, if it had never been detected, would never have caused symptoms during the rest of their natural lives (this is not ALL screen-detected patients, of course, but a significant number). How such unnecessary treatments can be minimised is a subject crying out for urgent attention!

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