Discussion about this post

User's avatar
Neil Steinmetz's avatar

In addition to the problems you discuss, a fundamental problem with the breast cancer screening study is that it only analyzes those subjects who actually developed breast cancer, not the entire screened population. As I commented elsewhere (Doximity):

“The conclusion in the abstract states, “Annual mammographic screening was associated with lower risk of late-stage cancer and better OS across clinical and demographic subgroups. Our study suggests benefit of annual screening for women 40 years and older.”

This is misleading, since the study analyzes data only for the subset of women in the screening population who actually developed and were diagnosed with breast cancer during the study duration. One would need to analyze data from the entire screened population to draw any conclusions as to whether there is an overall statistically or clinically significant benefit to screening and if so how it compares to the risks and costs of overdiagnosis.

If such a poorly designed study were actually accepted for publication, the limited conclusion actually supported by the study data should be modified to read as follows:

“Conclusion

Among the subset of subjects who developed and were diagnosed with breast cancer annual mammographic screening was associated with lower risk of late-stage cancer and better OS across clinical and demographic subgroups. Our study suggests benefit of annual screening for those women 40 years and older who actually develop breast cancer but does not assess the benefit, if any, of screening all women 40 years and older.”

In my view, the study authors, peer reviewers, and journal editor(s) all share the responsibility for adding such a misleading study conclusion to the literature on this important and highly controversial topic.

Expand full comment
Jim Ryser's avatar

One thing I like about reading sensible medicine on a Sunday is it keeps my brain from atrophying with the Sunday blues. Funny, how only four years into retirement I still dread Mondays…

Expand full comment
26 more comments...

No posts