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Rapid Responses: Rapid Responses published:
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Screening for breast cancer exclusively in women with Oncological Terrain.
- Sergio Stagnaro (16 January 2004)
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In the eye of the beholder.....
- Rosetta Manaszewicz (19 January 2004)
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Correction
- Georgana Hanson, MPH (20 January 2004)
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Yawn - yet another infodemiology study
- Gunther Eysenbach (21 January 2004)
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Rectification
- Louisa Beejay (21 January 2004)
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Breast cancer screening and radiation risk
- Lynn Howard Ehrle (5 February 2004)
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Sergio Stagnaro, Specialist in Blood, Gastrointestinal, and Metabolic Diseases. Researcher in Biophysical Semeiotics. Via Erasmo Piaggio 23/8 16037 Riva Trigoso (Genova) Italy
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Sir, I agree certainly with the authors’ statement “The information material provided by professional advocacy groups and governmental organisations is information poor and severely biased in favour of screening” (1). Unfortunately, they do not consider, or perhaps ignore, another reason of paramount relevance. It is to say that they take no notice of the significant developments of physical semeiotics occurred over the last five decades (See the website HONCode 233736, www.semeioticabiofisica.it), particularly as breast cancer primary prevention, and clinical diagnosis are concerned (2). In fact, in "all" cancer screening we must, first of all, carefully recognize and, then, select, at the bed side, all individuals at “real” risk of malignancy, but not other people without such as predisposition(2,3,4,5). That is, also these authors do not know the real existence and, consequently, they can not assess the seriousness as well as the precise location of a particular mitochondrial cytopathology, Congenital Acidosic Enzyme-Metabolic Histangiopathy, “Oncological Terrain” is based on (2,3,4 5). For instance, considering the well-known negative influence of oral contraceptive use on breast and/or ovary oncogenesis, and/or arterial disorders, we have firstly to take into account the importance of the genetic predisposition, now-a-days perfectly evaluated clinically in a “quantitative” way (See “Biophysical Constitutions” in above-cited website), as far as the onset of a large number of disorders is concerned, including solid as well as liquid malignancies. In fact, without the Oncological Terrain, i.e., the remarkable functional abnormality of psycho-neuro-endocrine-immunological system, oncogenesis is not possible at all, and consequently mammography is useless, a part from its negative side-effects, different in origin. Therefore, in oncological medicine, all around the world, the importance of the above-mentioned congenital mitochondrial cytopatology, and Oncological Terrain, should not be overlooked, particularly when we perform cancer screening programme. 1) Jørgensen KJ., GøtzschePC. Presentation on websites of possible benefits and harms from screening for breast cancer: cross sectional study BMJ 2004;328:148 (17 January), doi:10.1136/bmj.328.7432.148. 2) Stagnaro-Neri M., Stagnaro S., Cancro della mammella: prevenzione primaria e diagnosi precoce con la percussione ascoltata. Gazz. Med. It. – Arch. Sc. Med. 152, 447, 1993 3) Stagnaro S., Auscultatory percussion of the cerebral tumour: Diagnostic importance of the evoked potentials, Biol. Med., 7, 171-175 1985 4) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica condizione necessaria non sufficiente della oncogenesi. XI Congr. Naz. Soc. It. di Microangiologia e Microcircolaz. Abstracts, pg 38, 28 Settembre-1 Ottobre, 1983, Bellagio. 5) Stagnaro-Neri M., Stagnaro S. Introduzione alla Semeiotica Biofisica. Il Terreno Oncologico. Travel Factory, Rome, in press. Competing interests: None declared |
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Rosetta Manaszewicz, Steering Committee Member, Breast Cancer Action Group (Vic.) PO.BOX 381 Fairfield, Vic. Australia
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It is ironic that a paper purporting to reveal ‘bias’ in government and advocacy websites providing information on mammographic screening should itself be a prime example of both ‘bias’ and misleading information. Language may be as purposively misleading as statistics – why else do Jorgensen and Goetzsche repeatedly use the term ‘harms’ when discussing the risks associated with mammography? Is it coincidence that these authors, with their own personal axe to grind are the only researchers of note to resort to such language? Nor do they mention the ‘fact’ that the Cochrane Collaboration has consistently rejected their previous findings. So much for ‘balanced information’ and informed consent! But what is most disappointing about this publication is that the BMJ has allowed itself to become party to another attack on mammography whilst parading the paper as ‘research’ on website quality. Competing interests: None declared |
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Georgana Hanson, MPH, Clearinghouse Coordinator National Women's Health Network, Washington DC 20004
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First and for most I would like to thank the authors Jorgensen and Gotzsche for exploring the relationship between corporate funding and health information presentation and dissemination. As an organization dedicated to providing a critical analysis of women’s health issues, The National Women’s Health Network recognizes the significant influence such funding can have over those who provide consumers and policy makers with health information. That being said, I would like to offer a comment and correction on how the NWHN was categorized within the study. The authors placed us within the advocacy group category (“general purpose is to promote the interests of patients and their relatives”)while it is true that we are an advocacy group, we are also a consumer group (“general aim is to assess the quality of the health care services that are offered to patients and citizens”). I recognize that we are something of a hybrid and can be difficult to categorize. I am concerned however that the authors stated that all 13 advocacy groups included in the study accepted industry funding. The National Women’s Health Network has maintained a strict “no industry” funding policy since its inception in 1975. This policy has allowed NWHN to remain independent, and has earned us a reputation as one of the few organizations that provides accurate and reliable information on women’s health, free from industry influence. Competing interests: None declared |
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Gunther Eysenbach, Senior Scientist, Centre for Global eHealth Innovation Toronto M5G2K5
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Yawn - yet another "infodemiology" [1] study. This must be study #346 with the message "we searched information about [plug-in-your-topic-here] on the web and found that information on [plug-in-your-topic-here] is poor".
Amazing that the BMJ is still publishing these kinds of studies.
Also interesting is that authors affiliated with a Cochrane Centre fail to cite (or be aware of it) a relevant systematic review [2] which could have informed methods and discussion of this study. Some investigators still evaluate websites as if they were "information pamphlets". To evaluate the "comprehensiveness" of a printed pamphlet (where it can be assumed the patient is not using anything else) may make sense, but to evaluate a website under the aspect of completeness does not take into account that people are usually gathering information from different websites [3].
References 2. Eysenbach G, Powell J, Kuss O, Sa ER. Empirical studies assessing the quality of health information for consumers on the world wide web: a systematic review. JAMA 2002; 287: 2691-2700. [Abstract] 3. Eysenbach G, Köhler C. How do consumers search for and appraise health information on the World-Wide-Web? Qualitative study using focus groups, usability tests and in-depth interviews. BMJ 2002; 324: 573-577. [Full text] Competing interests: None declared |
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Louisa Beejay, Press Officer Breast Cancer Care, London, SW6 4NZ
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Breast Cancer Care believes the article raises some interesting issues and contributes to the ongoing debate on screening. However we strongly disagree with the statement that implies that we 'accept industry funding, apparently without restrictions'. Breast Cancer Care has to fundraise in order to provide services for anyone affected by breast cancer. Our commitment to service users is of paramount importance to us and therefore we are very selective about those companies from whom we will accept sponsorship. We are open about the sponsorship we receive from companies, such as Boots and Novartis, but under no circumstance is any aspect of our work, including our website, influenced by any company. Competing interests: None declared |
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Lynn Howard Ehrle, Senior Policy Analyst, National Association for Public Health Policy(US) 8888 Mayflower Dr., Plymouth, MI 48170 USA
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The wide-ranging and informative review of screening mammography(Juhl & Gotzsche, 17Jan)identifies corporate contributions as a determining factor in program and policy development by some breast cancer advocacy groups. Since non-profit nongovernmental organizations(NGOs)always are strapped for funds, corporations have found a fertile field for their "greenwashing" tactics. When non-profits take these monies they accept the corporate ethic that places profits above the public health, safety and welfare. In fact, some of their leaders have gone through the revolving door into the corporate sanctum sanctorum where they reach for The Golden Ring(1) while others act as surrogates for industry on federal agency advisory boards(2). The authors never mention the potential health risks from radiation, particularly when breast screening begins at age 40, as strongly recommended by the American Cancer Society and the National Cancer Institute(NCI), and you seldom see dose referenced(0.2-0.8rad, including retakes). The historical review, PREVENTING BREAST CANCER: THE STORY OF A MAJOR, PROVEN, PREVENTABLE CAUSE OF THIS DISEASE, by John W. Gofman, former associate director of Lawrence Livermore National Laboratory, lists 27 studies that quantify cancer induction linked to radiation(3). Cumulative dose should be a cause for concern as numerous studies now demonstrate there is no safe dose(threshold). Future screening studies should deal forthrightly with issues relating to x-ray dose and risk/benefit, indicating this information must be communicated to patients as required by the Nuremberg Code and the Helsinki Accords. References 1. Ehrle LH. Partnerships between universities and industry (letter). JAMA 2002;287:1398-1399. 2. Egilman DS, Ehrle LH. Handling conflicts of interest between industry and academia. JAMA2003;289:3240-3241. 3. Gofman JW. Preventing Breast Cancer: The Story of a Major, Proven, Preventable Cause of This Disease. San Francisco: Committee for Nuclear Responsibility Books, 1996(2nd ed). Competing interests: None declared |
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