The American College of Radiology (ACR) and Society of Breast Imaging (SBI) have issued a joint statement strongly criticizing an article published on Wednesday in the New England Journal of Medicine that takes aim at breast cancer screening programs in Switzerland.
In the NEJM commentary, co-authors Dr. Nikola Biller-Andorno, PhD, and Dr. Peter Jüni of the Swiss Medical Board discuss their recent report on breast cancer screening in the country. The report recommends that organized screening efforts in Switzerland be wound down due to questions about the benefits and harms of mammography screening.
ACR and SBI criticized both the commentary and NEJM's decision to publish it.
"The deadly consequences of the authors' breast cancer screening recommendations to the Swiss government may take years to become evident, may yet affect women in the United States, and were minimized -- if included in the article at all," they said in their statement. "The lack of a counterbalancing perspective, in such a major scientific journal, is surprising and concerning."
If routine breast cancer screening of all women ended in the U.S., 15,000 to 20,000 additional women each year would die from breast cancer, according to ACR and SBI. In addition, thousands more would endure more extensive and expensive treatments than if their cancers were found early by a mammogram.
The authors' claim that mammography does not save many lives through early detection of tumors is false, the organizations said. The U.S. National Cancer Institute found that the U.S. breast cancer death rate has dropped well over 30% since mammography screening became widespread in the mid-1980s, despite having remained unchanged for the previous 50 years.
ACR and SBI also said that randomized, controlled trials, such as those from Hellquist et al and Tabar et al, have reconfirmed that regular mammography screening cuts breast cancer deaths by roughly a third in all women ages 40 and older, not the 20% cited by Andorno and Jüni. Other studies have shown even greater benefits from mammography than those cited by the Swiss authors.
"When discussing doing away with screening programs that have been proven to save thousands of lives each year, this information is critical," ACR and SBI said.
While the NEJM authors pointed to the Canadian National Breast Screening Study (CNBSS) to support claims of overdiagnosis and mammography's ineffectiveness, their article did not include information about how CNBSS has been widely discredited, according to the organizations.
Every major U.S. medical organization with breast cancer care expertise recommends that women begin undergoing annual mammograms at age 40, and ACR and SBI said they continue to stand by these recommendations.
"Mammography can detect cancer early when it's most treatable and can be treated less invasively -- which not only save lives but helps preserve quality of life," they concluded.
