ASHINGTON,
March 14 A new analysis of mammography, the latest to address the question
of whether screening for breast cancer saves lives, has found that the tests
reduce the risk of dying from the disease by one-fifth.
The study, made public today by a Swedish team, said the benefits of
screening were greatest for women older than 55. Among younger women, the
benefits were not statistically significant, the team wrote.
The research is unlikely to settle the debate among scientists and
statisticians over the value of mammograms. But proponents of mammography
said the study bolstered their case, adding that the overall findings lent
credence to the government's recent recommendation that women older than 40
have the tests every one to two years.
"It adds yet more evidence to suggest that mammography screening reduces
mortality," said Dr. Steven Woolf, a professor of family medicine at
Virginia Commonwealth University who helped draft the government
recommendations. "It goes onto a pile of existing studies showing that
mammography is effective."
Routine mammograms have been a part of the lives of American women for
decades, but the debate on their usefulness has gone on for years. At issue
is whether the benefits of detecting tumors early, when they are small and
can be easily removed, outweigh the risks, which include false positive test
results and unnecessary surgery to remove tumors that might not be
dangerous.
The Swedish study is an updated analysis of four large Swedish clinical
trials that have been at the center of that debate. In October, scientists
in Denmark announced that they had found serious flaws in studies, including
the Swedish trials, that have been widely cited as proof of the benefits of
mammography.
The new review is, in effect, the Swedish rebuttal. Led by Dr. Lennarth
Nystrom of Umea University, the scientists extended their follow- up of
247,000 women in the four Swedish studies and re-examined an earlier
analysis in light of the Danish critique.
"The advantageous effect of breast screening on breast cancer mortality
persists after long-term follow-up," Dr. Nystrom and his colleagues wrote.
They called the Danish critique "misleading and scientifically unfounded."
The study, which appears in the current issue of the journal Lancet,
found that regular mammograms reduced breast cancer deaths among women of
all ages by 21 percent. When the authors adjusted their data to account for
criticism by the Danish group, that figure changed to 15 percent.
The study found that the benefits of screening became statistically
significant beginning at 55. Among 55- to-64-year-olds, for instance, deaths
among women who were offered screening were reduced 27 percent. By
comparison, the deaths were reduced 14 percent among 45-to-54- year-olds who
were offered screening.
Because the original studies intended to look at the benefits of
mammography overall, and not among particular age groups, a number of
experts today said that it was wrong to conclude that screening did not
benefit younger women. The correct interpretation of the data, they said, is
that the benefits of mammography increase with age.
"There's a continuum," Dr. Woolf said. "As women get older, the tradeoff
of benefit to harm becomes more favorable. There's nothing magical that
happens" at 55.
In an editorial accompanying the research, Dr. Karen Gelmon of the
British Columbia Cancer Agency in Vancouver said the study showed "real but
modest" benefits for screening and said the new analysis "reassures us that
the Swedish data are believable."
Proponents of mammography rejected that characterization of the benefits
as modest.
"I wouldn't use that word," said Dr. Peter Greenwald, director of cancer
prevention at the National Cancer Institute. "I think when you get a
reduction of one-fifth in deaths from breast cancer, that's very important."