Point: The New England Journal of Medicine Article Suggesting Overdiagnosis From Mammography Screening Is Scientifically Incorrect and Should Be Withdrawn.
The publication of the recent New England Journal of Medicine (NEJM) article [1] on the effectiveness of mammographic screening raises two major issues that I will try to address. The first is the lack of scientific rigor in the paper itself. The second is why a highly respected journal would publish such a flawed analysis. It should be clearly stated that mammography does not cause "overdiagnosis" or "overtreatment." Pathologists cannot distinguish cancers that will be lethal from those that do not require treatment, and oncologists cannot determine who will be cured without systemic treatment and who will be "overtreated." Palpable cancers are routinely "overtreated." Thirty percent of women treated by mastectomy alone in the 1940s were alive 30 years later. Because there is still no way of identifying women with similar cancers today, all now receive systemic therapy. None of these women benefit from this therapy, and so are all "overtreated." Unfortunately, approximately 40,000 women still die each year from breast cancer. Almost all receive systemic therapy that does not save them. Would opponents of screening argue to stop all treatment, sacrificing those who actually benefit? Women should not be denied access to screening and its potential to save lives simply because all of medicine (not just breast cancer treatment) is inexact. There is nearly universal agreement (including the US Preventive
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