Here we go again
Here we go again and again
Wondering how it all began
Wondering will it ever end
Round and round we go
Where it's going nobody knows
Though I know we've been
This place before...
John Lennon, Phil Spector
In a commentary on the mammography controversy published in Diagnostic Imaging six and a half years ago,2 I discussed how two prestigious groups of scientists analyzed data from the eight most commonly recognized clinical trials on screening mammography conducted to date and arrived at opposite conclusions. The first group, the U.S. Preventive Services Task Force, concluded that mammographic screening to detect early breast cancer was efficacious and clearly saved lives. The second group, the Nordic Cochrane Center in Denmark, the head scientist of which is Dr. Peter Gøtzsche, concluded that mammography not only fails to reduce deaths from breast cancer but may even do more harm than good. I concluded that the mammography controversy would persist for many years and that the two sides of the story—one supportive without reservation, the other claiming that mammography is of little or no value—would continue to attract public attention.
As predicted, claims and counterclaims regarding the efficacy of mammographic screening have continued to be published in the scientific literature and have periodically captured the attention of the news media, which stories have, in turn, attracted public attention. One recent study showed that screening mammography resulted in a reduction in deaths from breast cancer of up to 44%.3 Another recent report, based on a meta-analysis of randomized controlled trials, however, concluded that the reduction of deaths due to breast cancer attributable to mammography was as low as 7%.4 One nationally known radiologist-mammographer's disagreement with the latter report was so vehement that he characterized it as “misleading and an outrage.”5
Just as the controversy over the efficacy of mammography seemed to be quieting down somewhat, in February Gøtzsche and colleagues fired a new salvo against mammography in a British Medical Journal article entitled, “Breast screening: the facts—or maybe not.”6 Gøtzsche et al strongly criticized public health officials in the U.K. for informing the British public about the benefits of screening mammography but among the harmful effects enumerated by Gøtzsche and his group were that “[t]he likelihood of women being overdiagnosed after mammography is 10 times greater than the likelihood of their avoiding death from breast cancer,” and “overdiagnosis and subsequent overtreatment of healthy women result in 30% more surgery, 20% more mastectomies, and more use of radiotherapy.”6
