Mammography screening has little or no effect on breast cancer deaths, Swedish data indicateBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e4847 (Published 17 July 2012) Cite this as: BMJ 2012;345:e4847
All rapid responses
As Susan Mayor  reports, the recent study by Autier et al.  provides further evidence that screening has had little, if any, effect on mortality from breast cancer. But this is challenged by two accompanying editorials. [3,4] Isn’t it strange that after more than 30 years of research and the widespread use of breast cancer screening, we’re none the wiser?
Segnan et al.  want an end to the strife. “It’s time to move beyond the apparently never ending debate about the extent to which screening for breast cancer in the 1970s to 1990s has reduced mortality from breast cancer…” Their view seems to rest on the acceptance of screening as being a beneficial intervention. But this is precisely what is in question; this, after all, is what drives the conflict. Calling for a truce is convenient when the status quo is in line with your view. Yet the arguments marshalled on the other side – most notably by Peter Gotzsche  – hold considerable weight. The critics of breast cancer screening appear to be in the ascendancy and cannot be expected to join some cosy silence while, as they believe, women worldwide are lured into a programme that offers so little benefit and causes harm.
Years of large-scale randomised controlled trials and epidemiological studies have failed to provide clear cut answers regarding the overall benefit of breast cancer screening. The situation is the same with respect to colorectal cancer screening and many therapeutic interventions especially in the field of chronic disease.  Endless disputes fill the medical literature but these are usually confined to the minutiae of studies and progress is seldom made.
Statistics-based research will not deliver the solution because it is the source of the problem. It is responsible for the questionable data which spawn the interminable quarrels. But, what’s worse, it leads to millions of individuals being subjected to ineffective treatments and interventions as well as to a substantial waste of increasingly scarce health-case resources. 
1. Mayor S. Mammography screening has little or no effect on breast cancer deaths, Swedish data indicate. BMJ 2012;345;e4847.
2. Autier P, Koechlin A, Smans M, Vatten L, Bonio M. Mammography screening and breast cancer mortality in Sweden. J Natl Cancer Inst 2012, doi:10.1093/jnci/djs/272.
3. Vannier MW. Screening mammography: what good is it and how can we know if it works? J Natl Cancer Inst 2012, doi:10.1093/jnci/djs289.
4. Segnan N, Rosso S, Ponti A. Is the breast cancer mortality decrease in Sweden due to screening or treatment? Not the right question. J Natl Cancer Inst 2012, doi:10.1093/jnci/djs290.
5. Gotzsche PC, Nielsen M. Screening for breast cancer with mammography. Cohcrane Database Syst Rev 2009 (4): CD001877.
6. Penston J. Stats.con – How we’ve fooled by statistics-based research in medicine. The London Press. November 2010.
Competing interests: No competing interests