Earlier this year a research paper published in the prestigious British medical journal LANCET by two Danish statisticians came to the conclusion that routine mammograms were not doing what we have been led to believe. They concluded that mammograms did not detect early cancer and that this did not save lives. They based their conclusions on reanalyzing a number of already reported studies. (They did no original studies of their own.) They selected three studies, which they believe were "properly" performed, and rejected seven studies because they found some deficiency in the methods reported. This they believed made the conclusions suspect.

On the other hand, essentially all the experts in Europe and in the United States, including the National Cancer Institute, and every major cancer organization in America rejected their conclusions and substantiated the life saving benefit of annual mammograms. The frenzy in the press about this controversial paper in LANCET led to headlines in the national newspapers, arguments on editorial pages, and confusion in the minds of many women - unnecessary and unrewarding. In the end the conclusions of these two statisticians have been rejected worldwide and we are quietly returning to our usual urging of women to proceed with their annual mammograms because they do save lives.

Last month the same prestigious journal, LANCET, published an important paper on mammography in Holland, which examined data for almost 28,000 women between the ages of 55 and 74 who died of breast cancer between 1980 and 1999. When they compared data in 1986 and 1988 to the data in 1997 and years thereafter, there was a 20% drop in mortality in those communities where screening had been done after 1989. The statistics for this study are irrefutable with the conclusion that routine mammography can INDEED reduce deaths from breast cancer in women 55 to 74 years old. So why haven't we heard this very positive report in screaming headlines of the national press, on television, on the radio or anywhere else? Selective reporting of cancer related issues appears to be concerned with creating doubt and confusion rather than informing, and has to be sensational.

Another example occurred about a month ago. There were a number of front page reports questioning the role of PSA in detecting prostate cancer. Since the introduction of PSA over a decade ago, there has been a continued sustained decrease in deaths from prostate cancer. Furthermore, we now see most cases coming for treatment when the disease is still localized rather than as we saw it 10 and 15 years ago after it had already spread throughout a man's body. Most experts give credit to annual prostate screening programs with a blood test for PSA and the digital rectal examination. So when the newspapers had a front page story creating doubt in the minds of men about the PSA test, this was a matter of some concern, particularly since the medical papers they were reporting actually indicated that the PSA may be more sensitive than we have given it credit. Younger men may benefit from having PSAs done before the age of 50 and that the suspicious level may not be over the usually accepted 4.0 but at 3.0. For high risk men (African-Americans and those with a family history) this really extends the usefulness of the PSA in discovering early prostate cancer for younger men whose life expectancy can be seriously affected by leaving an unsuspected, undetected cancer, untreated until the disease is more advanced. It appears that this brouhaha has now faded from the scene and hopefully it has done some good in the medical community and not left any scars in the people we serve, who need to consider the usefulness of annual prostate screening.

For more information and answers to specific questions contact the Rhode Island Cancer Council at Tel@ricancercouncil.org or call us at (401) 728-4800 or toll free 866-879-4100.

IT IS EASIER TO PREVENT CANCER THAN TO TREAT IT.

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