In Letter To Schroeder, Boxer, Love Supports NCI Decision

The following letter was sent by the author to Rep. Patricia Schroeder (D-CO) and Sen. Barbara Boxer (D-CA). The letter refers to Boxer’s and Schroeder’s questioning of NCI Director Samuel Broder, as reported in The Cancer Letter, March 18.

I read with some distress your questioning of Dr. Broder from the National Cancer Institute regarding mammography screening in women under 50. Please let me expound on the issues.

There is no question in my mind that we should not recommend routine screening of all women under 50. Nine randomized, controlled studies have failed to show a difference in mortality from breast cancer in women under 50 who had been mammographically screened.

This is not to say that young women don’t get breast cancer. They certainly do. The point, however, is that mammography screening is not the best tool for its detection. There are many reasons for this.

One is that young women often have denser breasts on mammography, less suited for x-ray visualization. In addition, the incidence of breast cancer is lower. This means many more women would have to be submitted to the risks of radiation, extra biopsies, and extra anxiety to find very few cancers.

It has been estimated that, even if mammography worked as well in women under 50 as in older women (where it reduces the mortality rate by 30 percent), you would have to screen 1,000 women yearly for ten years to save one woman’s life.

For every 1,000 mammograms there will be 700 extra procedures and/or biopsies to find 15 breast cancers and miss seven. This just isn’t a cost effective tool.

The other argument used by enthusiasts is that mammographic technology has improved, so if older studies were repeated today, they would show a difference.

This is unlikely. Every study has shown that mammography screening in women over 50 works well. It consistently decreases the mortality from breast cancer by 30 percent.

What is interesting is that this figure of 30 percent is the same whether the study was done in the 1950’s or more recently, with improved technology. It is likely that there is a subset of women who can benefit from mammography screening (about one third) and improvements in technology won’t alter this figure very much.

This is a case where more is not necessarily better. We need to be lobbying for a tool which will work in women under 50, not fighting for something which doesn’t work very well. And, where this tool has been shown to be life-saving, we need to make sure that every woman over 50 has access to free mammography.

Susan Love
Director, Breast Cancer Center
Univ. of California, Los Angeles

 

Bernard Fisher And The NSABP:

Controversy Cannot Tarnish A Career That Helped Millions

To the Editor:

Having read the recent reports about the National Surgical Adjuvant Breast & Bowel Project, I was moved to express my personal sense of profound sadness at this unfortunate turn of events.

I know that I express both personal feelings and objective scientific and intellectual facts when I state that I can think of no physician-scientist who has contributed more to our understanding of the basic biology of cancer, to its management, and to the benefit of the literally millions of individuals with cancer and their families than Dr. Bernard Fisher.

I know that my views are shared almost uniformly and universally by physicians and scientists around the world.

In 1993, our institution joined the legion of others in honoring Dr. Fisher for his scientific and intellectual contributions by awarding him the Jeffrey A. Gottlieb Memorial Award. This award recognizes physicians and scientists who have made signal contributions to cancer therapeutic research and it honors a young, brilliant physician-scientist who died at the age of 35 in 1975 from the disease we have all worked so hard to contain.

It is certainly not necessary for me to recite the honors that have been bestowed upon Dr. Fisher for the qualities of scientific integrity, brilliant intellect, fluent communication, both verbal and in writing, and joyous, positive, expansive personality to match the intellect that goes along with it.

Dr. Fisher, as an individual, has had a profound impact on the entire body of the knowledge which relates to the biology of cancer. His recognition of the fundamental importance of the systemic nature of localized cancer is a milestone in our understanding of the behavior of tumors.

I am confident that current events could not possibly tarnish the brilliant, creative, and productive career of this great person and I personally certainly hope that it will not interfere with his ability to continue to play a leadership role in advancing our knowledge of the biology of cancer and its ultimate control.

Emil J Freireich
Director, Adult Leukemia Research Program
Univ. of Texas M.D. Anderson Cancer Center

 

A Lesson In Ethics?

To the Editor:

A Fisher’s Tale

Once upon a time they apprehended a slovenly pickpocket in the far reaches of the kingdom with a fresh-picked wallet in his hand. They called the king’s ministers who ordered him tapped on the wrist of his misguided extremity. They forbade him to put his hand in any pocket for a full eight days. Then, after confiscating the wallet, they ordered the owner executed for not shouting “Stop, thief!” loud enough.

Thus they taught the citizenry that pickpockets are bad-they spoil the reputation of the kingdom and embarrass the king. And, as for owners, well….

James Holland
Distinguished Professor of Neoplastic Diseases
Mount Sinai Medical Center