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Mammography Questioned, Inconclusively

February 24, 2011
Written by: , Filed in: Breast Imaging
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Mammography has little or no association with the declines over the past three decades in breast cancer mortality rates  in many Western countries, according to a new study that examined published data covering the period from January 1990 through June 2009.

Does that summation seem a little carefully worded? Or wishy-washy? Well, the study’s a little hard to pin down too.

The data cover parts of Australia, Italy, the Netherlands, Norway, Switzerland, Ireland, Scotland, and the United States. In all of the areas, mammography screening participation increased during the years of the study, especially the early years, eventually reaching rates ranging from 60 percent in Firenze, Italy, to 88 percent in Rhode Island.

In its article about the study, published last month in the Annals of Oncology, the European-American research team wrote, “Mammographic screening aims to detect cancer at an earlier stage that would be less life threatening and easier to cure than if detected clinically. … Hence, a reduction of advanced cancer incidence should reflect the impact of screening activities alone.”

In other words, the researchers theorized that mammographic screening should catch breast cancers at a stage earlier than they otherwise would be detected. So increased screening should coincide with decreased rates of advanced cancer.

But that’s not what the data show:

In contract, this study found that in general, incidence rates of advanced breast cancer did not change much despite 7–15 years of good participation in mammographic screening.

The article continues: “There were variations in some areas, with transient downward trends. These, however, were followed by increases back to prescreening rates.”

The researchers ask, “What are the possible reasons for modest or no reduction in the incidence of advanced breast cancer?”

Their answer, in so many words (519, to be precise): We don’t know. Maybe more data would help.

To be fair, the researchers acknowledge limitations in their study, including gaps in their data regarding the size of breast cancers detected during mammograms. Reading the article, you start to feel sorry for them. These guys put in a monumental amount of work sifting through data, and they ended up knowing nothing more than when they started. Perhaps even less.

So it goes in the mammography wars. If these particular researchers wind up frustrated, well, why should they be any different from anyone else involved?

Related seminar: Breast Imaging and Digital Mammography

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