In Support of Mammographic Screening

Screening mammography has been having a hard time lately in the medical literature and popular press. While seven large-scale randomized trials have been conducted to evaluate its efficacy, controversies remain regarding which of these trials were of sufficient quality to provide reliable information on which to base a public policy decision. Certainly, the consensus in the United States for the past 20 or more years has been in favor of mammography. However, recent criticism from a Danish group has shaken the confidence of the medical community, and certainly of the public, with regard to this screening modality.

In our own NewYork Presbyterian Hospital community, Dr. Claudia Henschke and her colleagues (Drs. Mark Pasmentier, James Smith, Daniel Libby, and David Yankelevitz), working with a world-renowned epidemiologist, Dr. Olli Miettinen of McGill University, recently published a paper in the Lancet [2002 Feb 2;359(9304):404-5] in support of mammographic screening. This paper argues that the impact of breast cancer screening can only be fully appreciated with longer-term follow up. Moreover, the Malmo Randomized Trial, which provided 10-11 years of follow up, was found to be methodologically sound, and showed a 55% reduction in the breast cancer fatality rate at that point in time.

The research team has previously made important methodological contributions in the use of spiral CT scans for lung cancer screening, and is widely recognized as the leading experts in this area (see CT Scan Lung Cancer Screening Tests). They have now extended their influence into another cancer screening controversy.

Editor's note:
Claudia Henschke, PhD, MD, is Professor of Radiology and Chief of Chest Imaging Division at NewYork Presbyterian Hospital, Weill Medical College of Cornell University.