Clin­i­cal stud­ies should clar­ify de­bate on cancer screen­ing, not cloud it

Modern Healthcare - - COMMENT -

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.

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