International Journal of Epidemiology, Volume 33, Number 1, pp. 43-55
IJE vol.33 no.1 © International Epidemiological Association 2004; all rights reserved.
Point-Counterpoint |
On the efficacy of screening for breast cancer
1 Department of Statistics, University of California, Berkeley, CA 94720–3860, USA
2 Kaiser Permanente, Southern California, Pasedena CA 91188, USA
3 Harvard School of Public Health, Boston MA 02115, USA
Background ‘Mammography’ (screening for breast cancer by X-ray examination) came to be widely—although not universally—accepted in the 1980s when a number of clinical trials demonstrated a substantial reduction in risk. Early detection, before the disease spread, permitted therapy that was simultaneously less invasive and more effective. Questions that remained were largely about efficacy for younger women and optimal frequency for older women. The consensus was challenged in a series of papers by two researchers at the Nordic branch of the Cochrane collaboration, Gøtzsche and Olsen, who concluded that mammography does not save lives: instead, it exposes women to unnecessary surgical procedures.
Methods Qualitative review.
Results The basis for the Gøtzsche–Olsen critique turns out to be simple. Studies that found a benefit from mammography were discounted as being of poor quality; remaining negative studies were combined by meta-analysis. The critique therefore rests on judgements of study quality, but these judgements are based on misreadings of the data and the literature.
Conclusion The prior consensus on mammography was correct.
Keywords Mammography, breast cancer, screening, meta-analysis
Accepted 24 June 2003
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