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Screening Mammography |
Irogers{at}ajroffice.org
Unfortunately, some medical writers seem to be adopting the ways of TV political punditry. Watch out! Recently The New York Times, following the lead of The Lancet, attempted to bury screening mammography in an avalanche of adverse publicity.
The seemingly exponential increase in the number of medical reporters and media outlets has significantly magnified the attention paid to developments in medicine. On the whole, this must be considered as good. However, there is a down side; on occasion, this added scrutiny sheds more heat than light.
Some writers and media persona seem driven by a craving, even a lust, to be important. Lust is a deadly sin. In a writer's quest for celebrity, facts may be overlooked or distorted. In a reporter's lust for the sensational, the truth may suffer. Even otherwise good and well-intentioned people can be blinded by the lust "to do good" or "to be somebody"—the craving to "make an impact." When you want something so badly, you can go astray.
How better for reporters and editors to gain notoriety than to unroof a conspiracy or expose false claims and prove the experts wrong? The medical profession is particularly fair game in this endeavor. Get those doctors!
When it comes to radiology and diagnostic imaging, what better target for reporters than mammography? Mammography is a sensitive and highly charged issue. Because the imaging of breast disease is of considerable interest to the general public, media reports that question the validity of mammography are likely to stir up a fuss. Fan the flames of public concern with negative publicity and you might make a name for yourself.
Even the celebrated big boys of publishing, the so-called best, such as The Lancet and The New York Times, are not immune to the siren call of "doing good," making a splash with the big story. In their quest to expose the evils of this world, news organizations and even medical journals can get just as carried away, be just as deluded, and become just as lost as individual reporters when attempting to satisfy the editorial desire to do "great" things.
In this issue, Kopans [1] defends screening mammography. He responds to a recent campaign by The New York Times [1] to discredit the impact of screening mammography on the death rate from breast cancer. The Times based its campaign on an article published in The Lancet [2]. Be sure to read Kopans' article. It not only will assist you in answering questions about the validity of screening mammography but also will alert you to the slipshod and pernicious practices of some reporters and editors. To be forewarned is to be forearmed. Kopans is to be commended for his informative and spirited response to these scurrilous attacks.
According to Kopans [1], The Lancet article [2] represents a republication of an article that had previously appeared in The Lancet [3]. The data in the republication were based on a rereview of prior publications concerning the impact of mammographic screening on breast cancer. Republication of an article after a rereview of the data is highly unusual. Furthermore, according to Kopans, it is also unclear whether the republication [2] was subject to The Lancet's usual peer-review process. Did The Lancet attempt to substantiate these authors' claims? Or were the editors of The Lancet so taken by the potential publicity that they failed to check the facts of the matter?
In any event, Olsen and Gotzsche [2] concluded, as they had in their initial article in The Lancet [3], that mammographic screening has no impact on the death rate from breast cancer. This conclusion contradicts most of the world's respected authorities in this field who maintain that mammographic screening has reduced the death rate from breast cancer by 25-30%.
Nonetheless, and based on this dubious, negative republication in The Lancet [2], The New York Times raised an alarum by embarking on a campaign to denigrate and discredit screening mammography. Needless to say, The Times' articles and editorials created a furor and anxiety among many women. The Times undertook this effort despite the fact that most authorities the world over have long ago repudiated the conclusions republished by The Lancet. Did The Times attempt to substantiate the claims found in the republication? Or were the editors of The Times so taken by the potential publicity that they, like The Lancet editors, failed to check on the facts of the matter? Is The New York Times now "The Tabloid Times"? Has The New York Times lost its way?
I would like to think that The Lancet and The New York Times and their editors, authors, and reporters were simply naive and misguided in their zeal to inform. The possibility that there was deliberate and knowing misrepresentation of the facts is far too disturbing to contemplate.
Let's face it: radiologists have little to apologize for when it comes to the development of screening mammography for breast cancer. Improvements in the imaging of breast disease disclose early and curable cancers: small, non-palpable, even minute breast cancers that are undetectable by any other means. This has led to a significant improvement in the outlook for women with breast cancer. Radiology may have things that we should apologize for, but mammography and the imaging of breast disease is clearly not one of them.
Thank you, Dr. Kopans!
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