Q. Where did I get the data on an almost 64-percent reduction in mortality for women who get regular mammograms?
A. Dr. Laszlo Tabar, who is one of the most respected physicians and researchers in the area of breast cancer and early detection, advanced the notion of an almost 64-percent reduction in mortality for women who get regular mammograms. See this publication in Cancer, (2001, pp 1723-1731) “Beyond Randomized Controlled Trials.”
To give our audience some background, most Randomized Control Trials (RCTs) that dealt with mammography in the 1960s and 1970s, such as the Health Insurance Plan of New York (HIP Trial) or the Swedish Two County Trial (WE Trial) put women into one of two arms: a control arm where they were not offered mammography; or a study arm, where they were offered mammography.
However, over time, we noticed that some women who were in the “not offered” arm of the study actually came and got a mammogram anyway. They were not turned away, but their results were still kept in the “not offered mammogram” arm of the study. And some women who were offered mammograms did not actually get them, but their results were still kept in the “offered mammogram” arm of the study.
Tabar, in 2001, went back and looked (retrospectively, albeit) at his data from the Two County trial. He looked at the women who actually got mammograms versus the women who actually did not get mammograms and found almost a 64-percent reduction in mortality for women who actually got mammograms over the women who actually did not.
Q. Why do your recommendations conflict with those of the U.S. Preventive Services Task force (USPSTF)?
A. Most of my research colleagues cannot understand how the USPSTF could have ignored information from the multiple RCTs and metadata analyses when drawing their conclusions. The only thing we can surmise is they chose to ignore the scientific data in lieu of making a value judgment, or they had a predetermined agenda.
For instance, in addition to the Tabar data that was presented to them, they were shown multiple randomized controlled trials that demonstrated excellent survival benefits of mammography, as well as several meta-analyses upholding that data.
The graph above demonstrates concrete results from countries that, in the late 1980s, began comprehensive programs in breast cancer screening. Notice how the death rate from breast cancer dropped precipitously in the years that followed, and these results were with only part of the female population being screened. Imagine how much better the results would have been if most or all women were screened.
Michael J. Ulissey, M.D., is a partner at the Breast Diagnostic Centers of Auburn and Federal Way. He received his medical degree from Texas A&M University, College of Medicine and subsequently served as a physician in the U.S. Navy. His career since has been a mix of private practice, academic teaching and research in the fields of breast imaging, breast cancer and early detection. In addition to taking care of patients locally, he continues to participate in research as an Adjunct Professor at the University of Texas Health Sciences Center. You can reach him at Mike@breastdiagnostic.com.
