From time to time, [i]Menopause Live[/i] and [i]Our Menopause World[/i] monthly literature review bring information on the everlasting debate concerning the value of screening mammography. The recent paper by Raftery and Chorozoglou, published in the [i]British Medical Journal[/i], underestimated lives saved by mammography screening by half . Now the American College of Radiology has sent a harsh press release accusing the investigators of falsifying the data. Here are pieces of that communication.
“[i]The estimated 15% reduction in breast cancer deaths used in this study is the same used in 2009 by the US Preventative Services Task Force. That estimate has been discredited by a series of large randomized control trials and other data that prove the benefit is at least twice that…The US government disavowed those recommendations and barred insurance companies from using them in coverage decisions… No one can tell which cancers will never advance and which will become lethal. Therefore, until science can help to differentiate them, surgeons and medical oncologists will treat these patients, even though a small number of them may not benefit from treatment. The bottom line is that we know that discontinuing regular mammograms will result in thousands more breast cancer deaths each year. That human cost would be too high.”[/i]
Providing medical care always involves balancing benefits and risks and considering cost-effectiveness parameters. We, as clinicians, are the ones who make the decisions, and therefore must constantly update ourselves and realize that any policy that we follow is subject to debate and revision. Every physician has his own views and experience, which may be largely influenced by colleagues and media reports. It is sometimes very difficult to reach an unbiased, scientifically sound, personal treatment algorithm, but we must at least keep our mind open to hear other views and be flexible in regard to our own decision-making process.
The International Menopause Society is marking 2012 as the 10-year anniversary of the Women’s Health Initiative (WHI) trial. The WHI results and the endless debates and commentaries that followed are a very good example of the complexity of human biology and drug therapy. I believe that, 10 years after the first release of the WHI results, we can reach conclusions on postmenopausal hormone therapy that most menopause experts will accept as guidelines. The IMS hopes to bring its updated views and suggested recommendations for hormone therapy at the end of 2012.
On behalf of the IMS and the team for [i]Menopause Live[/i] and [i]Our Menopause World[/i] – Lee, Jean and myself, we wish all of you a happy and healthy New Year.
Raftery J, Chorozoglou M. Possible net harms of breast cancer screening: updated modelling of Forrest report. BMJ 2011;343:d7627.