But while the report is new, the underlying data has been available since March of 2002, when The Lancet, a widely respected British medical journal, published the Swedish update, known as a meta-analysis—a statistical procedure in which the results of the five independent trials were added together to mimic one gargantuan trial.
Although I wrote about the update on the front page of the Chicago Tribune, I was the only American reporter at the accompanying Stockholm news conference. The American Cancer Society, and the American College of Radiology, whose members make their living reading mammograms, continued to urge women to begin annual mammograms at age 40.
Now that the task force has changed its recommendation, it seems possible that billions of health-care dollars may have been misspent on mammograms for women under 50—or, according to the Swedish update, under 55—that were either unnecessary, or which caused women needless psychic and physical trauma.
Granted, biostatistics are not easy to understand, and harder to explain to a lay audience. But the current controversy over the task force's report owes much to the media's confusing coverage, some of which has been misinformed, including by TV doctors who ought to know better.
The confusion has been abetted by the American Cancer Society, whose position appeared to have softened, then hardened again, in recent weeks.
Last month, Dr. Otis Brawley, the cancer society's chief medical officer, was quoted in the New York Times admitting "that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.''
Another Times article quoted Dr. Susan Love, a leading breast surgeon, calling the under-50 question “the third rail” and praising Brawley for questioning the status quo.
“I really don’t think we should be routinely screening women under 50,” Love told the Times. “There’s no data showing it works.”
I wasn't surprised by Brawley's statement, since he had expressed the same view to me when we met at a cancer symposium in Milan in 2003. Following the task force report's release, however, Brawley appeared to change direction, telling The Times that the cancer society had concluded that the benefits of annual mammograms beginning at 40 "outweighed the risks" and that the ACS was sticking by its earlier advice.
"He's trying to save his job," one of Brawley's colleagues said. "He was broiled at home for the interview in which he said that we (the medical establishment) are 'overselling' screening."
In his recent comments, the ACS's Brawley has repeated that regular screening mammograms reduce the incidence of breast cancer in women age 40 to 50 by 15 percent—the same finding as the seven-year-old Swedish update. It should be noted that before the update, mammography advocates had been claiming that regular mammograms could reduce the risk of dying from breast cancer by a whopping 30 percent. The update knocked that number down, putting the benefit for women age 40 to 74 at 20 percent, a number The Lancet described as "modest," and for women 40-49 at 15 percent.