BETHESDA, MarylandThe scientific conflict about whether mammography saves
lives has been reignited by the decision by an independent advisory committee
to rescind its support for such screening and to emphasize the uncertainty of
the evidence supporting it.
The decision once again puts PDQ (Physician Data Query) at odds with the
recommendations of the National Cancer Institute. The NCI recently reaffirmed
PDQ is a database for health care providers and the public that provides evidence-based assessments of cancer
treatments, screening techniques, and prevention approaches.
At a January 23rd meeting, the PDQ screening and prevention editorial board
concluded that the evidence for mammography screening in women remains
uncertain and does not warrant definite conclusions about its use. The group
decided that changes needed to be made in PDQ’s website discussion of
mammography, but did not formulate a new wording at its meeting.
Although the use of mammography to screen women between ages 40 and 49 has
been most controversial, the board decided that some uncertainty exists for
women of all ages.
The PDQ board acted in large part on the basis of two articles published in
The Lancet by Ole Olsen, MSc, and Peter C. Gøtzsche, MD, of the Nordic
Cochrane Center, Copenhagen, Denmark.
In January 2000, the two researchers reported their assessment of results
from randomized trials that have been used to support screening mammography and
concluded that the analysis failed to show that such screening actually saved
lives. They also concluded that screening led to more aggressive treatment that
increased the number of mastectomies by about 20% and the number of tumorectomies
by about 30%. In their latest article, published in the October
20, 2001, issue of The Lancet, they reported that their new analysis of seven
screening trials confirmed the 2000 report that "that there is no reliable
evidence that [mammography] screening for breast cancer reduces