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European Study Reignites Mammography War

August 2, 2011
Written by: , Filed in: Breast Imaging
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Oh, boy. “Mammography screening by itself has little detectable impact on mortality due to breast cancer.”

That’s the conclusion of a study that appeared Thursday in the online edition of the British Medical Journal (BMJ). The study analyzed World Health Organization data for three pairs of neighboring European countries. In each pair, one country had initiated nationwide mammography screening much earlier than the other.

The pairs were:

  • Sweden, which began implementing mammography screening in 1986 and achieved nationwide coverage in 1997, and Norway, which began national screening in 1996 that was fully implemented in 2005. From 1989 to 2006, breast cancer mortality decreased by 16.0 percent in Sweden and 24.1 percent in Norway.
  • The Netherlands, which started a screening program in 1989 that reached full coverage in 1997, and Belgium, which began rolling out a national program in 2001. From 1989 to 2006, breast cancer mortality decreased by 25.0 percent in The Netherlands and 19.9 percent in Belgium (24.6 percent in the Flanders region, which is closest to The Netherlands).
  • Northern Ireland, which introduced national screening in the early 1990s and achieved full implementation in 1995, and the Irish Republic, which introduced national screening in 2000 and reached full implementation in 2008. From 1989 to 2006, breast cancer mortality decreased by 29.6 percent in Northern Ireland and 26.7 percent in the Irish Republic.

So why is breast cancer mortality declining across Europe if not because of early detection attributable to screening mammograms? “Improvements in treatment and in the efficiency of healthcare systems may be more plausible explanations,” the study says.

The day after the study appeared, the American College of Radiology and the Society of Breast Imaging released a joint statement that began, “There is a large body of evidence that mammography screening saves lives.” It went on to say, in an underlined passage:

The conclusions of the BMJ study authors have little bearing on, or resemblance to, screening in the United States.

And then it listed five specific flaws in the BMJ study, including: “Just because two nations share similar geography, does not mean their breast cancer mortality trends are easily compared.”

So have we learned anything? The BMJ study carefully couches its conclusions in such terms as “suggest,” “may be,” and “adds further population data to the evidence.” It reinforces existing doubts about the benefits of mammography screening. But its evidence is suggestive, not conclusive.

In other words, no, we haven’t really learned anything new. We just have a bit more to think about.

Related seminar: Pittsburgh Breast Imaging Seminar


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