Screening mammography advocates and defenders are responding in force to the recent study published in BMJ questioning the value of mammography.
The study, as reported Feb. 12 in FierceMedicalImaging, found that according to data from the Canadian National Breast Cancer Screening Study (CNBCSS), death rates from breast cancer were similar in women who underwent mammograms and those who didn't.
However Mitva Patel, M.D., a breast radiologist at the Ohio State University Comprehensive Cancer Center, pointed out in a recent commentary published to Live Science that the CNBCSS has been publicly denounced as a non-reputable source of data by professional medical organizations such as the American College of Radiology and the Society of Breast Imaging.
According to Patel, the Canadian trial used second-hand mammography machines with outdated technology; its images were compromised by scatter, making cancers more difficult to see; the technologists producing the data weren't trained to properly position the breast; and the radiologists reading the images weren't properly trained in mammographic interpretation.
"Would you want a radiologist who typically analyzes images of the stomach to interpret your mammogram?" Patel asked.
Patel added that she and her colleagues at the Stefanie Spielman Comprehensive Breast Center at The Ohio State University Comprehensive Cancer Center continue to "stand behind the American Cancer Society's recommendation that women age 40 or older have a screening mammogram every year."
At Memorial Sloan Kettering Cancer Center, Larry Norton, M.D., the center's deputy physician-in-chief for breast cancer programs, echoed Patel's sentiments, calling the BMJ study a "further follow up of a flawed study" in a statement.
"There are no new data here, so it should not influence any changes in screening recommendations," Norton said.
Anthony Miller, lead author of the BMJ study has rebutted these criticisms, but one thing is clear--as David Katz, M.D., director, Yale Prevention Research Center, points out--there is a long history of research on this subject, and conclusions have been anything but consistent.
"There are many reasons why decisive evidence that mammography confers net survival benefit at the population level, or that it lacks benefit and should be abandoned--is elusive," Katz wrote in a commentary for the Huffington Post. "The result is something of a muddle for epidemiology. Until technology, interpretation, application and histopathological confirmation all rise to consistently high standards, we can't unmuddle mammography for populations."