Clinical studies should clarify debate on cancer screening, not cloud it
Regarding the recent article “Mammography debate heats up with new study” (ModernHealthcare.com, Feb. 12), when I was a young physician (I am now 71), many women had metastatic breast cancer at diagnosis or soon thereafter. I had the sad duty to sit at the bedside of many women dying of breast cancer. This changed with the introduction of mammography in my community in the early 1980s and may have been complemented by tamoxifen (introduced in the late 1970s), but surely is not because of tamoxifen alone. Only a very small percentage of women in my prac- tice were ever treated with tamoxifen, and the decrease in metastatic breast cancer was in the order of 80%.
Mortality from breast cancer in women having regular mammograms has gratifyingly decreased substantially, and it defies logic to ascribe this to anything other than mammography. Ditto for the use of PSA (prostate-specific antigen) in detecting early and curable prostate cancer.
We do need further scientific study to reduce overtreatment of breast and prostate cancer, but certainly not a movement away from early diagnosis of lethal cancers. No one can assert that all of the cancers diagnosed early by mammography and PSA are nonlethal. This is where research should be focused. Not on nonblinded studies that cloud the debate more than clarifying it.
Dr. Abe Levy Bonita Springs, Fla.