Do mammograms matter? Maybe no.

     Yesterday I shared here what many of us deem terrific news about what the new Affordable Health Care Act covers for women. Today I offer a tad of caution, not about health care reform, but about how comfortable we may become with accepted and standard women's health advice and practice. This news may disconcert.

      The 'British Medical Journal' reports that data-analysis from three separate, paired, long-term European reviews suggest, contrary to researchers' expectations, that screening has no effect on breast cancer deaths. While overall breast cancer mortality has declined a great deal in first-world nations, the study reports that it's very hard to know "how much of the decline is due to early detection, or the efficiency of the health care system".

     Researchers looked at very large 'natural experiments' in three nation-pairs where some had "instituted regular mammography screening significantly earlier than the others, but their health care systems and socioeconomic" profiles were the same. (A 'natural experiment' report is one not based on an arranged scientific inquiry but instead analyses existing data.) The matched-pairs were

          Northern Ireland/The Republic of Ireland;

          The Netherlands/Belgium; and

          Sweden/Norway.

     In all three paired countries, "earlier implementation of screening had no effect on mortality." For instance, in Northern Ireland, screenings were implemented in the early '90s and by '95 three quarters of women were getting mammograms. In the Irish Republic, screening wasn't introduced until 2000 "and it was not until 2008 that 76% of women were screened." And yet from 1989 until to 2006 breast cancer deaths decreased 29% in Northern Ireland and almost as much in the Republic of Ireland. Similar results stemmed from the studies in the other paired countries.

     While the lead researcher, Dr. Philippe Autier, says he was surprised by the results, his team concluded that mamography screening does not work. I'd be interested to see if similar data, collected and studied, say, in a decade (or current data from other nation pairs, should they exist), substantiate or challenge this report.

     There seems no harm, now, in women getting mammograms. Dr. Autier does not suggest there is. The question I have, and one I think you should have, too, is that should another similar study or two evidence the same conclusion, are there better avenues for our health care outlays?

     It's important, no matter how disquieting, to take seriously challenges to conventional wisdom. If (in any area) money can be better allocated than it now is, all families potentially benefit. My hope is that this study is replicated and that additional current data may be analysed. While we tend to take comfort in current thinking and practice, we need to augment public policy on the strength of increasing and solid, confirmed knowledge.

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IMPORTANT NOTE:

I want to be sure that you understand that this post is not about, nor is it an outgrowth in any way, of the controversial decision, last fall, of the U.S. government panel's recommendation to raise the age at which most women first ought to have mammograms. The scientists who reported the findings in this post have nothing whatever to do with that panel's work or recommendations.  -JW