Letters
Cancer
Volume 178 - Issue 4

In reply: Screening mammography and mortality

Author:  Alan Rodger

Med J Aust 2003; 178 (4): 190.
Published online: 17 February 2003
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In reply: In his letter, Gøtzsche is clearly under the misapprehension that, in using the figure of speech "gives the lie to", I am accusing him of lying. Nothing could be further from the truth. As he quotes, I applied that phrase to his conclusions. In my Australian Oxford Dictionary1 to "give the lie to" can mean — and it is this meaning that I was applying — "serve to show the falsity of a supposition".

I was replying to Gough's response2 to my editorial3 on breast screening. He clearly showed that breast screening was unlikely to reduce overall mortality. I agree. I believe, therefore, that Olsen and Gøtzsche are wrong in supposing that analysis on the basis of breast cancer mortality is inappropriate, and that only overall mortality should be considered. Gough argues for this better than I can.

Being an editor of the Cochrane Breast Cancer Group does not require me to accept every supposition or conclusion in a Cochrane review. The whole point in publishing a scientific paper — as part of the Cochrane Library or in a peer-reviewed journal — is to open it, after appropriate review, to public scrutiny, scientific comment and even criticism. Their Cochrane review4 has succeeded in achieving all of this.5

Lastly, I reiterate my comments in the editorial3 that mammographic breast screening detects breast cancers that are "smaller, less likely to involve nodes and, if node positive, more likely to involve fewer nodes." In other words, if the TNM (tumour–node–metastasis) system means anything, there is a better prognosis with such breast cancers than with those detected clinically. Perhaps Gøtzsche needs to add a clinical oncology perspective to his undoubted expertise in the finer details of trial methodology analysis.

Author

  • Alan Rodger

Competing interests

I am Chair of the Board of BreastScreen Victoria, and a member of the editorial group of the Cochrane Breast Cancer Group.

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