Some of the Many Views of Mammography
By: New York Times
February 5, 2002
The news that some researchers were challenging the
benefits of yearly screening mammograms has provoked widespread confusion
and debate. Science Times asked a number of those involved in the debate
about their views. Following are excerpts from their replies.
DR. EDWARD A. SICKLES,
professor of radiology at the University of California at San Francisco.
"From my vantage point as a radiologist I think the evidence
indicating the benefits of mammography is overwhelming, so I'm not
troubled by these revisionist thinkers who are claiming that hundreds of
trials were done incorrectly."
DR. STEPHEN BRENNER,
private practice, New Haven.
"It has created a lot of confusion. I think doctors are very insecure
about telling women to stop getting mammography or telling them it's not
worthwhile."
"I've shared with them the information that I
know from the Lancet article and I've told them I feel it's best to go
with whatever they feel most comfortable with. I'm not advising them one
way or the other. I'm trying to make them understand the limitations of
the test and letting them make their own decision."
DR. PRISCILLA SHUBE,
family practitioner in Swansea, Mass.
"I do still recommend mammography in the same protocol that has been
traditional, mostly because I've seen articles in the newspaper like
everyone else, but I haven't actually seen the criticisms of the previous
studies. I haven't gotten enough information to change the
recommendations. Mammography has been the traditional recommendations for
so long, and this is just one voice that's saying maybe you should rethink
this."
DR. REBECCA A. ZUURBIER,
director, Betty Lou Ourisman Breast Health Center, Washington.
"Mammography has never been safer or more accurate than its present
state. The current reconfiguration of old data wrongly understates the
benefits of screening mammography."
DR. MICHELE C. CURTIS,
obstetrician-gynecologist, director of the Prime Time Clinic for
menopausal women, Lyndon B. Johnson General Hospital, Houston.
"What I'm telling my patients right now is that I still advise them
to get mammography.
"There's no such thing as the perfect study and
you don't normally change what you do on the basis of one study.
"For the last 25 years we've been screaming at
you to get your mammograms, now suddenly you're getting a completely
different message. Before we all stop midstream and backpedal let's look
at the evidence, let's duplicate it and make sure this is telling us what
we think it's telling us.
"I don't think women want to go back to the days
of thinking that there's absolutely nothing they can do to detect breast
cancer early. I think most of us physicians are more willing to be
cautious; it's a test that doesn't cause any harm."
RUSSELL HARRIS,
member, P.D.Q. (Physician Data Query) advisory board, which issued report
on mammography for the National Cancer Institute; co- director, program on
prevention at the University of North Carolina Medical School.
"I do think that the message from all this is that the decision to
have or not to have a mammogram shouldn't be quite so knee-jerk.
Physicians and patients just need to stop and think about this a little
bit. It's not quite so simple as we first thought. It's not that
mammograms are a bad thing and nobody should get them and it's not that
they are so wonderful that everybody should get them. It's something in
between, and that's a harder public health message."
DR. LARRY NORTON,
breast cancer specialist at Memorial Sloan-Kettering Cancer Center;
president, American Society of Clinical Oncology.
"The downside of continuing with mammograms is very small. The
consequences of stopping screening prematurely could be disastrous. You
can't go back and fix it if you miss a cancer that could have been helped.
It's better to err on the side of caution at this point, pending scholarly
review of all the information."
DR. LESLIE R. LAUFMAN,
oncologist, 55, Hematology Oncology Consultants, Columbus, Ohio; member,
two panels that have reviewed mammography data for the National Cancer
Institute.
"I just think that mammography's usefulness is overrated, and there
is no data supporting annual versus less frequent mammograms. It's been a
couple of years since my last one and I have no plans to have another one
now. I don't know what to do. I'm no longer just marching along doing them
annually without thinking about it."
SENATOR TOM HARKIN,
Democrat of Iowa, who will hold hearings on mammography.
"There is considerable controversy surrounding the Danish study and
women deserve a clear answer. I am personally convinced that had my two
sisters had access to mammography that they would not have died so young
because of this terrible disease."
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