Eleven years ago, two researchers from the Nordic Cochrane Centre in Denmark, Ole Olsen and Peter Gøtzsche, published a paper in The Lancet on screening for breast cancer with mammography. This three-page paper, accessible here as a full report was to have a remarkable impact on their professional lives. Here’s a synopsis:
“Mammographic screening is of uncertain benefit and leads to greater use of more aggressive treatment. By detecting cancers early, mammographic screening is widely believed to lead to reduced mortality from breast cancer and to less aggressive treatment. Half a million women have participated in randomised trials worldwide. This review failed to find a decrease in overall mortality, and the best trials also failed to find a reduction in breast cancer mortality. The review found that screening leads to more aggressive treatment.”
The Cochrane Collaboration is a registered charity, established twenty years ago, that consists of almost 30,000 volunteers in more than 100 countries. On the basis of scientific reviews of published research articles, sometimes called meta-analyses, the Cochrane Centres assist clinicians to make the best health care decisions for their patients. Despite the fact that he was the Director of his regional Centre and had been present at Oxford in 1992 when the first Centre was established, Gøtzsche found himself being discredited by the editors of the Cochrane Breast Cancer Group, the very people he thought would be supportive. This negative experience is one of the reasons that led him to publish a book on screening mammography with the provocative subtitle Truth, Lies and Controversy.
Gøtzsche’s book provides a rare insight into the characters and issues that have framed the recent heated debates on breast cancer screening. With chapter titles such as “Ad hominem attacks: a measure of desperation?” and “What have women been told?”, the author doesn’t mince his words. He concludes, “Hundreds of millions of women have been seduced into attending screening without knowing it could harm them. This violation of their human rights is the main reason we have done so much research in mammography screening and also why I have written this book.”
At CapeRay we take the views of contrarians like Peter Gøtzsche seriously even if his recommendations could be counterproductive to our business. While we are dedicated to the design of innovative diagnostic tools, we also recognise the importance of seeking the truth.
In the breast world Peter Gøtzsche has always been regarded as the grumpy old man.He has angered many screeners. And yet, there is much truth in what he writes, and we have – as you have – to listen. He probably brings the pendulum to a balanced middle view, away from the hysterical feminist lobby, those people who claim that all the medical breast world wants to do is “slash, poison and burn!” And the most guilty people, they claim, are the xxy’s!
Many thanks for this follow-up, David. I think you’re spot-on about the pendulum swinging and the need for us all to come to a balanced view. Jimmy Volmink, Director of South Africa’s Cochrane Centre and Dean at Stellenbosch, has also been in touch and said he would be meeting with Peter Gøtzsche in Paris next month. I would definitely like to engage Peter in further debate.
No doctor can ever pridect the future especially with cancers- though we are asked to do this every day.If she is old ( how old ?), she may die of natural causesbefore the breast cancer progresses to affect her health.I do not see why she would refuse a simple lumpectomy,but maybe she is very old.We have so little medical information here.Her doctor has all of her medical history and has examined her.That is the person to ask.I’ve seen people with advanced breast cancers live for many years.