Mammograms or Mammoscams?
| Mammography and the politics of randomised controlled trials, BMJ (1998) |
The debate over the necessity of screening for breast cancer among women in their 40s has assumed an importance out of proportion to its potential impact on public health. Even among women over 50, for whom screening significantly reduces mortality, the actual number of deaths involved is comparatively small. Some commentators (for example, the Center for Medical Consumers and the National Breast Cancer Coalition) feel that the controversy over mammography has diverted attention from the more pressing problem of our ignorance about how to prevent breast cancer.36 Why has this issue become so important, and why do feelings run so high among the public, politicians, and health professionals? Thirty five years of randomised trials of mammography have not produced a universally acceptable answer to the question of its efficacy in younger women; in fact, different experts have often drawn opposite conclusions after analysing the same data. The mammography story illustrates some of the many obstacles to putting research findings into clinical practice. When trials do not give an unequivocal answer, when politicians and interest groups become involved, and when the professionals responsible for promoting the public's best interest fail to do so, objectivity is likely to suffer. |
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