A reply from Dr. Leonard Berlin

Dr. Kopans criticizes me and others for being “unable to break free of doubts” about the efficacy of mammography and says those who suggest there is ambiguity in its benefit are using “unscientific data analyses” and “scientifically unsupportable” data that have “been manipulated to generate doubt.”

Despite these assertions, there are credible questions about mammography. Just this year there have been a plethora of articles in various medical journals that highlight such potential downsides of screening mammography as overdiagnosis. As Dartmouth professor H. Gilbert Welch wrote in a British Medical Journal editorial this past July, overdiagnosis is a “vexing problem,” and causes some women to undergo unnecessary treatment. Welch, however, does not disparage mammography; instead, he writes, “Mammography is one of medicine's 'close calls'-a delicate balance between benefits and harms-where different people in the same situation might reasonably make different choices. Mammography undoubtedly helps some women but hurts others. No right answer exists; instead it is a personal choice.”

As I wrote in my April 2009 Diagnostic Imaging article, I believe there is sufficient, albeit not incontrovertible, evidence that mammography does reduce mortality from breast cancer, and that radiologists and other physicians should, after discussing both the pros and the cons of screening, encourage but not coerce women to undergo annual screening mammography. At the same time, however, acknowledging rather than denying the existence of controversies regarding mammography will assist the public at large to develop a realistic appraisal of mammography's role with regard to breast cancer.