Posted on: Sunday, December 30, 2001
Island Voices
Breast cancer screening does not reduce deaths
By Dr. John McDougall
Mammography fails because it is a crude technique that most often finds cancer only after it has been growing for eight to 12 years.
The Cochrane review on screening mammography, published Oct. 20 in the medical journal Lancet, has created an emotionally charged stir in the medical business and many responses to try to control the damage.
A systematic review of the randomized trials of mammography by the highly respected Nordic Cochrane Center came to the conclusion "that there is no reliable evidence that screening for breast cancer reduces mortality," and "that screening leads to more aggressive treatment."
Many other highly respected researchers have come to similar conclusions. In 1995 Dr. Charles Wright, clinical professor at the University of British Columbia, reported in the Lancet his conclusions after reviewing the data: "Since the benefit achieved is marginal, the harm caused is substantial, and the costs incurred are enormous, we suggest that public funding for breast cancer screening in any age group is not justifiable."
Prior to this, writing in a 1989 edition of the British Medical Journal, M. Maureen Roberts, clinical director of the Edinburgh Breast Cancer Screening Project since 1979, stated that "We can no longer ignore the possibility that screening may not reduce the mortality in women of any age, however disappointing this may be. ... I believe that a rethink is required before the programme goes any further. I feel sad to be writing this; sad because naturally after so many years I am sorry that breast cancer screening may not be beneficial. I am also sad to seem to be critical of the many dear and valued colleagues I've worked with over the years, particularly those who have made such a magnificent contribution to the care and welfare of women with breast cancer. But they will recognize that I am telling the truth."
Roberts' article was published posthumously after her death from breast cancer.
Mammography fails because it is a crude technique that most often finds the cancer in the breast only after it has been growing there for eight to 12 years. By this time, if it is truly cancer, it has spread to other parts of the body, beyond the reach of surgery or radiation. Unfortunately, our methods of dealing with disease that has spread are of limited benefit.
Beyond the billions of health care dollars fruitlessly spent, what are the real harms to a woman from mammography? Fear and anxiety surrounding this test take a toll on her daily life. Once an abnormality is found on a mammogram, she will likely have surgery. In eight out of 10 cases, the lump is not cancer — so surgery was unnecessary.
If she is diagnosed with cancer, her whole world changes: she can no longer get life or health insurance, a career may no longer be available, and now everyone worries about "the breast cancer victim." Furthermore, if the tests and treatments really do add little for a woman's chance of surviving, then think of all the unnecessary costs, pain and suffering caused by surgery, radiation, and chemotherapy — and all the disappointment that follows false hope.
The burden of proof lies with those who recommend tests and treatments. If you believe that the Cochrane review, Charles Wright, Maureen Roberts and many other respected researchers are correct that "screening for breast cancer with mammography is unjustified," then it is way past the time when we should have brought this universal medical practice in line with the scientific evidence.
Unfortunately, politics, pride, fear of malpractice suits and billions of lost dollars will allow this behemoth to continue trampling the health and welfare of women. Finally, for my colleagues, I paraphrase Maureen Roberts: "But you will recognize that I am telling the truth."
Dr. John McDougall is a former Hawai'i physician and creator of the McDougall Program for Women.
