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Editorials

The harms and benefits of modern screening mammography

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3824 (Published 17 June 2014) Cite this as: BMJ 2014;348:g3824

Re: The harms and benefits of modern screening mammography

It is difficult to understand why Drs. Elmore and Harris, two professors of medicine, are so much against early diagnosis and treatment of breast cancer in its early stages. They are commenting on mammography screening, but the real issue is early detection of the disease. They propose women not be diagnosed early
because there is access to very expensive chemotherapy treatment with short and long lasting physical, cognitive, emotional and psychological damage; also, the advanced stage of the disease causes real human suffering. Their comments about the impact of treatment are speculation taken from thin air, without any supporting data. Without individual patient data nobody can tell the relative benefit of treatment versus screening, and none of those authors who are against screening have access to individual patient data!

In their Editorial they mention the Canadian trials that have been declared a “national embarrassment” by Dr. Paula Gordon, professor of Radiology in Vancouver, Canada, but do not give proper credit to the eight truly population based randomized controlled trials. This is a biased selection of the relevant literature.

Their comment “The Norwegian study largely confirms what is already known: the benefits of screening mammography are modest at best” is interesting. In contrast to the Norwegian authors, Elmore and Russell Harris do not appear to understand the difference between “screening” (i.e. attending screening) and “invitation to screening”; had they read the article carefully, they would have realized that “Attendance was associated with a 37% lower risk” of dying from breast cancer. Calling these results “modest at best” speaks for itself. Elmore and Harris should have written about the “harms and benefits” of mammography screening in a more balanced way such as: The potential harm of attending versus the real harm of not attending mammography screening. I strongly recommend that Drs. Elmore and Russell Harris read the thorough articles by Dr. S Feig et al., Dr. Duffy et al and Dr. J Malmgren et al. regarding this important issue (1-3).

László Tabár, MD

References
1. Feig SA, Duffy SW. Screening results, controversies and guidelines. In: Bassett LW, Mahony M, Apple S, D'Orsi C, editors. Breast imaging. Philadelphia: Saunders; 2010. p. 56–75.
2. Duffy SW, Chen TH-H, Smith RA, et al. Real and artificial controversies in breast cancer screening. Breast Cancer Manage. (2013) 2(6), 519–528.
3. Malmgren JA, Parikh J, Atwood MK, Kaplan HG. Impact of mammography detection on
the course of breast cancer in women aged 40–49 years. Radiology. 2012;262:797–806

Competing interests: No competing interests

18 June 2014
Laszlo K Tabar
radiologist
Department of Mammography
Falun Central Hospital