Breast cancer screening controversy. (Round Up: Research).

The latest study on breast cancer screening has found that screening does save lives after all. The news has been welcomed by screening advocates as an end to two years of heated controversy. Researchers from Umea University found that there was a "modest" benefit from breast screening in all women

from the age of 55, but not before. However, full benefits of ongoing screening programmes may only become evident after 10 years (1). An earlier review by researchers at the Nordic Cochrane Centre concluded that there was no reliable evidence that mammography screening reduces mortality from breast cancer, and that screening is associated with an increased risk of mastectomy and tumourectomy. This generated a storm of controversy within medical and research circles, reflecting a long-standing lack of consensus on the issue (2,3). The reviewers, Olsen and Gotzsche, are investigators with the respected Cochrane Collaboration's Cochrane Breast Cancer Group, but the editors of the Group disowned the review (2). Issues raised by the controversy included the subjectivity of research, data analysis and interpretation in general, and the quality of the original studies and data. Olsen and Gotzsche's review itself has been questioned for its reliance on two studies out of a set of seven, which some claimed affected the conclusions (3). Also under scrutiny is the validity of previous Cochrane Collaboration reviews which, according to one survey (incidentally led by Olsen), tend to overvalue the benefits of new treatments (2,4). The most substantial issue, however, is the implications of the findings for women as well as for health care systems and policymakers. (2-4)

In a related development, according to a study by the Collaborative Group on Hormonal Factors in Breast Cancer, eight out of nine women who develop breast cancer do not have an affected mother, sister or daughter. Although women who have first-degree relatives with a history of breast cancer are at increased risk, most will never develop it. (5)

(1.) Boseley S. Breast cancer 'really does save lives': Study hailed for ending two years of controversy over benefits. Guardian. 15 March 2002, p. 9.

(2.) Horton R. Screening mammography: an overview revisited [commentary]. Lancet 2001;358(20 October):1284-5.

(3.) Mayor S. Row over breast cancer screening shows that scientists bring "some subjectivity" into their work. BMJ 2001;323(27 October):956.

(4.) Olsen O, Gotzsche P. Cochrane review on screening for breast cancer with mammography. Lancet 2001;358(20 October):1340-2.

(5.) Collaborative Group on Hormonal Factors in Breast Cancer. Familial breast cancer: collaborative analysis of individual data from 52 epidemiological studies including 58,209 women with breast cancer and 101,986 women without the disease. Lancet 2001;358(20 October):1389-99.

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