International Group of Experts Defends Mammography

Zosia Chustecka

November 17, 2011

November 17, 2011 — An international group of 41 breast screening experts has written a staunch defense of mammography in a letter published in the November 19 issue of the Lancet.

"Organized high-quality breast screening is an important public health initiative by numerous governments worldwide," the group writes. "These policies are based on robust and extensive analysis of individualized patient data from scientific trials, with particular attention paid to the balance of potential benefits and harm."

The letter is signed by health professionals involved in breast screening in many different countries, spanning Europe (Austria, Belgium, Denmark, Finland, France, Germany, Hungary, Italy, Luxembourg, the Netherlands, Norway, Portugal, Sweden, Switzerland), the United Kingdom (Eire, England, Jersey, Northern Ireland, Scotland, Wales), Canada, and Australia.

"To claim that such an international action is mass misrepresentation, or that screening is done for the benefit of self-interested professionals is as perverse as it is unjustified," the authors declare.

Such accusations have been targeted at mammography and the radiologists who carry it out over the past few years, as previously reported in some detail by Medscape Medical News. Criticism of mammography, and the leaflet explaining it, has been particularly vocal in the United Kingdom, and has prompted a governmental review of the national breast screening program.

Much of the criticism of mammography has been based on analyses carried out at the Nordic Cochrane Center. In their letter, the experts single out this group and accuse them of orchestrating "an active antiscreening campaign."

"Their specific aim seems to be to support a preexisting opposition to all forms of screening," they add.

The letter highlights a recent review from members of this group (Radiology. 2011;260:621-627) — entitled "Is mammographic screening justifiable considering its substantial overdiagnosis rate and minor effect on mortality?" The review was conducted by Karsten J. Jørgensen, MD, and Peter Gøtzsche, MD, from the Nordic Cochrane Group in Copenhagen, Denmark, and John Keen, MD, from the Stroger Hospital of Cook County, Chicago, Illinois.

Their interpretation of the balance of benefits and harms in that review is "scientifically unsound," the letter signatories assert.

"These contrary views are based on erroneous interpretation of data from cancer registries and peer-reviewed articles," they add.

"The signatories...remain convinced that the scientific foundation for population-based, quality-assured, organized breast screening is one of the major accomplishments of the translation of clinical cancer research into public health practice," the letter concludes.

The 41 signatories of the letter have disclosed no relevant financial relationships.

Lancet. 2011;378:1775-1776. Full text

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