Dr. Daniel Kopans of Massachusetts General Hospital is calling for the withdrawal of a paper published in the November 22 issue of the New England Journal of Medicine.
The paper, authored by Dr. Archie Bleyer and Dr. H. Gilbert Welch, states that despite significant increases in the number of cases of early-stage breast cancer detected since the 1970s, screening mammography has only marginally reduced the rate at which women present with advanced cancer (NEJM, November 22, 2012, Vol. 367:21, pp. 1998-2005).
Kopans' comment, published in current issue of the Oncologist, challenges the paper's arguments against mammography screening and states that most are based on faulty nonscientific analyses (February 2014, Vol. 19:2, pp. 107-112).
"The analysis used in this paper is fundamentally flawed, and the conclusions are not scientifically supported," Kopans wrote. "The paper's methods are questionable, and the conclusions are incorrect. The paper should be withdrawn by the New England Journal of Medicine."
The American College of Radiology (ACR) and the Society of Breast Imaging (SBI) lauded Kopans' commentary.
"Dr. Kopans has raised disturbing questions about the validity of the NEJM paper," the two organizations said in a statement. "We believe that healthcare recommendations should be based on scientific evidence and not on estimates, extrapolations, and guesses. The NEJM should carefully consider withdrawing this paper."
In a response also published in the Oncologist (pp. 113-126), Bleyer expressed disappointment in Kopans' commentary.
"Both my co-author and I are disappointed by the critic's comments because to mitigate the problem of overdiagnosis, primary care practitioners, surgeons, oncologists, and the public health community will all need the help of our colleagues in mammography," he wrote. "And the first step in addressing any problem is to acknowledge it."
