An Emerging Battle on Both Sides
For many years, patients have been told that it's important to get screening tests and annual exams covering various health benchmarks. The general attitude was that screening tests are a good thing and might save your life. Times have changed, though. Healthcare authorities have narrowed the use of some routine screenings for certain conditions. Such changes, however, have spurred strong resistance from some clinicians. Has the pendulum swung too far the other way?
Some experts have concluded that the use of screening tests for some cancers and other conditions has gotten out of control. These tests, they warn, create their own set of health hazards by identifying people who never would have been affected by the targeted disease and are then put through treatments that cause anxiety, pain, and disfigurement.
Citing these concerns, efforts are underway to limit screenings like mammograms and prostate-specific antigen (PSA) tests. This new restrictive approach, however, is meeting stiff resistance from many doctors and patients—particularly screening for breast cancer, which affects 1 in 8 women at some point in their lives.
"Don't throw out screening tests," pleads Karen Evans, MD, a family physician in Fort Wayne, Indiana, who underwent a bilateral mastectomy. She defends mammograms and PSA tests from skeptics who think they're overused. Dr Evans concedes that these tests have some flaws, but "don't stop now," she says. "Continue until we have a better test that picks up the cancer."
Whatever its flaws may be, "mammography does save lives," says Debra Monticciolo, MD, a Texas radiologist who chairs the Commission on Breast Imaging at the American College of Radiology (ACR). "Screening can catch cancer early, and when it's caught early, there are better chances of successful treatment."
The battle over mammography in particular has been raging in the journals, where countless scientific studies present conflicting conclusions about the value of these tests. Just in the past few years, mammography skeptics have unleashed several major studies and opinion pieces in some of the leading scientific journals, including the New England Journal of Medicine, Journal of the American Medical Association,and BMJ.
In contrast, studies that support mammography are often found in less well-known journals. Asked to name a more accurate study of the mammography issue than the ones cited above, Dr Monticciolo cited a literature review of European studies in the Journal of Medical Screening, which found that mammography screening programs overdiagnosed breast cancer in just 1%-10% of cases. Harvard radiologist Daniel Kopans, MD, has accused the New England Journal of Medicine in particular of "publication bias against mammography," and he demanded that it withdraw a study it published. Of the 14 articles the journal published on mammography from 1992 to 2012, all of them opposed widely accepted screening criteria, he wrote. (The journal hasn't responded to the charge.)
The scientific debate has gotten so heated that Russell P. Harris, MD, an internist at the University of North Carolina, Chapel Hill, issued a plea last year to "end the duel" over mammography and reach agreement on the science behind the research. In the Journal of the National Cancer Institute last November, he wrote: "We need to convene an international panel of impartial methodologists to develop standards for trustworthy observational studies."
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Cite this: Leigh Page. Should Women Have Fewer Mammograms? What's Right? - Medscape - Sep 30, 2015.