Ny Times article slamming mammography screening

pitanga · October 2011

Ladies, have you seen this article in the New York Times?

Maybe as a stage 4 patient I am oversensitive but it made my blood boil.

I would sure like to meet some of the women with "bad" cancers who were not helped at all by their disease being flagged early via mammo. By "not being helped" does the writer mean they eventually ended up dying of their disease anyway? Sure, aggressive cancers are the most difficult to treat but when they are picked up early the woman can gain quite a few more years of life.

well.blogs.nytimes.com/2011/10/24/mammograms-role-as-savior-is-tested/#preview

Not to be cynical but I can´t help wondering if the physician involved in the study was getting kickbacks from the insurance industry!

VictoriaB · October 2011

This is a poorly written and sensationalistic article that made my blood boil too! Early detection was a blessing, in my case.

LeapFrog39 · October 2011

I had early detection, but neither the mammogram or ultrasound helped. in fact, I was told by the radiologist to come back in 6 months. If my surgeon hadn't been as diligent as he was and I waited that 6 months, I would have been stage IV instead of stage II. I definitely think they should come up with something to screen women with dense breasts...something more cost effective than an MRI, which costs an arm and a leg!

That being said, it seems like there are plenty enough people who are helped by a mammogram that it shouldn't be dismissed as a diagnostic tool.

The"innocuous cancer" comment gave me pause. The doctor may consider it to be innocuous, but I doubt the cancer patient would agree with that.

CLC · October 2011

I am one of those that the article says was unnecessarily treated. DCIS, low grade. Total mastectomy. I don't feel unnecessarily treated. I know that my chances of survival probably hasn't changed. However, it is likely that I have escaped chemo and radiation as a result of my early detection. That means I have escaped a good deal of morbitity. Once again, the medical establishment fails to see quality of life as having value. Those are my two cents.

voraciousreader · October 2011

Here's the article:

OCTOBER 24, 2011, 4:01 PM

Mammogram's Role as Savior Is Tested

By TARA PARKER-POPE

Stuart Bradford

Has the power of the mammogram been oversold?

At a time when medical experts are rethinking screening guidelines for prostate and cervical cancer, many doctors say it's also time to set the record straight about mammography screening for breast cancer. While most agree that mammograms have a place in women's health care, many doctors say widespread "Pink Ribbon" campaigns and patient testimonials have imbued the mammogram with a kind of magic it doesn't have. Some patients are so committed to annual screenings they even begin to believe that regular mammograms actually prevent breast cancer, said Dr. Susan Love, a prominent women's health advocate. And women who skip a mammogram often beat themselves up for it.

"You can't expect from mammography what it cannot do," said Dr. Laura Esserman, director of the breast care center at the University of California, San Francisco. "Screening is not prevention. We're not going to screen our way to a cure."

A new analysis published Monday in Archives of Internal Medicine offers a stark reality check about the value of mammography screening. Despite numerous testimonials from women who believe "a mammogram saved my life," the truth is that most women who find breast cancer as a result of regular screening have not had their lives saved by the test, conclude two Dartmouth researchers, Dr. H. Gilbert Welch and Brittney A. Frankel.

Dr. Welch notes that clearly some women are helped by mammography screening, but the numbers are lower than most people think. The Dartmouth researchers conducted a series of calculations estimating a woman's 10-year risk of developing breast cancer and her 20-year risk of death, factoring in the added value of early detection based on data from various mammography screening trials as well as the benefits of improvements in treatment. Among the 60 percent of women with breast cancer who detected the disease by screening, only about 3 percent to 13 percent of them were actually helped by the test, the analysis concluded.

Translated into real numbers, that means screening mammography helps 4,000 to 18,000 women each year. Although those numbers are not inconsequential, they represent just a small portion of the 230,000 women given a breast cancer diagnosis each year, and a fraction of the 39 million women who undergo mammograms each year in the United States.

Dr. Welch says it's important to remember that of the 138,000 women found to have breast cancer each year as a result of mammography screening, 120,000 to 134,000 are not helped by the test.

"The presumption often is that anyone who has had cancer detected has survived because of the test, but that's not true," Dr. Welch said. "In fact, and I hate to have to say this, in screen-detected breast and prostate cancer, survivors are more likely to have been overdiagnosed than actually helped by the test."

How is it possible that finding cancer early isn't always better? One way to look at it is to think of four different categories of breast cancer found during screening tests. First, there are slow-growing cancers that would be found and successfully treated with or without screening. Then there are aggressive cancers, so-called bad cancers, that are deadly whether they are found early by screening, or late because of a lump or other symptoms. Women with cancers in either of these groups are not helped by screening.

Then there are innocuous cancers that would never have amounted to anything, but they still are treated once they show up as dots on a mammogram. Women with these cancers are subject to overdiagnosis - meaning they are treated unnecessarily and harmed by screening.

Finally, there is a fraction of cancers that are deadly but, when found at just the right moment, can have their courses changed by treatment. Women with these cancers are helped by mammograms. Clinical trial data suggests that 1 woman per 1,000 healthy women screened over 10 years falls into this category, although experts say that number is probably even smaller today because of advances in breast cancer treatments.

Colin Begg, head of the department of epidemiology and biostatistics at Memorial Sloan-Kettering Cancer Center in New York, said that he supports mammography screening and believes that it does save lives. But he agrees that many women wrongly attribute their survival after cancer to early detection as a result of mammography.

"Of all the women who have a screening test who have breast cancer detected, and eventually survive the cancer, the vast majority would have survived anyway," Dr. Begg said. "It only saved the lives of a very small fraction of them."

The notion that screening mammograms aren't helping large numbers of women can be hard for many women and breast cancer advocates to accept. It also raises questions about whether there are better uses for the hundreds of millions of dollars spent on awareness campaigns and the $5 billion spent annually on mammography screening.

One of the reasons screening doesn't make much difference is that advances in breast cancer treatment make it possible to save even many women with more advanced cancers.

"Screening is but one of the tools that we have to reduce the chance of dying of breast cancer," Dr. Esserman said. "The treatments that we have actually make up for a good deal of the benefits of screening."

The Dartmouth analysis comes two years after a government advisory panel's recommendations to scale back mammography screening angered many women and advocacy groups. The panel, the United States Preventive Services Task Force, advised women to delay regular screening until age 50, instead of 40, and to be tested every other year, instead of annually, until age 74. The recommendations mean a woman would undergo just 13 mammograms in her lifetime, rather than the 35 she would experience if she began annual testing at age 40.

But the new recommendations have scared many women who believe skipping an annual mammogram puts them at risk of finding breast cancer too late. But Donald Berry, a biostatistician at M.D. Anderson Cancer Center in Houston, said adding more screening is not going to help more women.

"Most breast cancers are not lethal, however found," Dr. Berry said. "Screening mammograms preferentially find cancers that are slowly growing, and those are the ones that are seldom deadly. Getting something noxious out of the body as soon as possible leads women to think screening saved their lives. That is most unlikely."

Dr. Love, a clinical professor of surgery at the David Geffen School of Medicine at the University of California, Los Angeles, says the scientific understanding of cancer has changed in the years since mammography screening was adopted. As a result, she would like to see less emphasis on screening and more focus on cancer prevention and treatment for the most aggressive cancers, particularly those that affect younger women. Roughly 15 percent to 20 percent of breast cancers are deadly.

"There are still 40,000 women dying every year," Dr. Love said. "Even with screening, the bad cancers are still bad."

voraciousreader · October 2011

Dr. Welch, mentioned in The New York Times article published a book a few weeks ago which discusses the limitations of various types of screening:

http://www.amazon.com/Overdiagnosed-Making-People-Pursuit-Health/dp/0807022004

Over on the Rancic thread I mentioned his book and all the recent studies questioning SCREENING mammograms benefit for our younger sisters.

There is NOTHING inflammatory, IMHO, about Tara Parker Pope's article. Instead, if you read all of the recent studies, you might arrive at the same conclusion that the folks quoted in the article did. And I will continue to shout from the roof tops that our younger sisters need a better SCREENING protocol and those with aggressive cancers need a cure.

Remember one other thing, that the article doesn't mention....There is a huge difference between DIAGNOSTIC and SCREENING mammograms. These studies are specifically referring to SCREENING mammograms. Futhermore, the article doesn't specifically discuss the data by age and that is important. SCREENING mammograms are an effective tool for women 50 to 69.

I wholeheartedly agree with the tone of the article and conclude that we need to recognize the limitations of SCREENING mammography for our younger sisters and need to work on finding better treatments and a cure.

I also recommend that everyone read Dr. Welch's book! Another important book is written by Harvard's John Abramson, MD, Overdosed America:

http://www.amazon.com/Overdosed-America-Promise-American-Medicine/dp/B000F5FNQG/ref=sr_1_1?s=books&ie=UTF8&qid=1319630410&sr=1-1

Dr. Abramson's book was published several weeks before the Vioxx debacle. His first chapter is about Vioxx.

These books are VERY enlightening and should be read.

voraciousreader · October 2011

BTW... In his book, Dr. Welch mentions that his wife was diagnosed with breast cancer. A DIAGNOSTIC mammogram picked it up.

Susie123 · October 2011

I guess I'm one of those women who think a "mamogram saved my life". I am very grateful for routine mamograms Before Age 50 as mine was found that way. It was so small the radiologist didn't even see it, the software on the digital mamo machine flagged it. It turned out to be the invasive kind. Do I think that if not found by that mamo it would have grown, absolutely, that's what cancer does, it grows. When it grows does it tend to spread to the nodes, absolutely. Is it harder to treat then, absolutely..so do I believe mamos don't effect outcome, absolutely not! A routine mamo saved my life!

Fearless_One · October 2011

As someone whose 4 years of mammos failed to find a nearly 2 cm tumor, I was not offended by the article. The author is saying a few things. First, that most cancers are not found by mammos (if authors numbers are accurate). Second, that mammos are not a cure and that with billions of dollars spent on research, we need more than mammos.

Oh- and my mammos were digital, diagnostic ones - not screening.

voraciousreader · October 2011

BTW...Regarding the article, there are over two hundred comments on Tara Parker Pope's site at The New York Times. Many of the comments are well worth reading. Tara also made the following comment:

If annual mammography costs $5 billion and saves 4,000 women, imagine if women and doctors followed the guidelines, reducing mammography screening to every other year, saving about the same number of women and saving $2.5 billion that could be spent on prevention research or treatment for aggressive cancers. How many grandmother, mothers, sisters and daughters could be saved with that money?

gardengumby · October 2011

OK - what exactly is the difference between a screening mammogram and a diagnostic mammogram?

voraciousreader · October 2011

According to Susan Love's website:

Screening and Diagnosis
What is the difference between a screening mammogram and a diagnostic mammogram?

A screening test is, by definition, a test that is done to screen people who are at risk for developing a disease but have no symptoms of it. The goal of screening is to save lives by finding the disease early, before people know that they have it. The Pap test, for example, is a screening test that is used to identify women who have cells on their cervix that indicate that they may be at risk of developing cervical cancer. Similarly, clinical breast exams and mammograms are done routinely on women who have no signs or symptoms of breast cancer to screen for the disease. The clinical breast exam may find a lump that a woman didn't know was present. The mammogram can detect microcalcifications, tiny deposits of calcium in the breast that may be indicators of breast cancer, or a tumor that cannot be felt through clinical breast exam.

A diagnostic test is, by definition, a test that is done to help make a diagnosis once signs or symptoms of a problem have appeared, such as a lump, pain, thickening, nipple discharge, or a change in breast size or shape. A diagnostic mammogram uses the same mammography machine, but because the test is being used to detect a possible problem it usually takes longer than a screening mammogram as more X-rays need to be taken.

voraciousreader · October 2011

This comment came from a physician reading the article:

As a physician, I would like to remind anyone reading this that the ultimate goal of cancer screening is not to find cancer. The ultimate goal is to extend life by intervening after screening has identified an asymptomatic cancer. If you find a cancer through screening that is going to kill you quickly, screening did not help you. If you find a cancer that could be cured later on if you skipped screening and waited until symptoms are present, then screening did not help you. If you find a slow growing asymptomatic cancer and then die from an unrelated condition, then screening did not help you.

I also want to remind readers that it is the role of organizations such as the United States Preventative Services Task Force and individual researchers to provide recommendations for the masses. It is your personal health care provider's job to take those recommendations (which are often conflicting), and the data behind those recommendations, and educate you so you can come to the decision that is best for you. Physicians far too often fail in this duty, and it is a shame.

voraciousreader · October 2011

A reader also mentioned this which was left out of the article but is important to know:

Please note that screening recommendations are for those who do not have an elevated risk of cancer. before reducing screening, it is VERY important to discuss family history with your health care provider, including breast and ovarian cancer on either side of the family, as hereditary breast and ovarian cancer can be passed through either father or mother. related cancers that may indicate elevated risk include cancers of the fallopian tubes, peritoneum, prostate and pancreas, as well as male breast cancer. the new recommendations do NOT apply to those with a significant family history and/or a known related genetic mutation in the family.

gardengumby · October 2011

OK - thanks, that was what I thought, but wanted clarification. Then I had a screening mammogram that found DCIS, LCIS and invasive. They say mine was "slow growing", and I was religious about getting yearly mammograms, but nonetheless the area affected by DCIS was approximately 6 cm, the largest invasive was 13 mm and it had moved into my lymph. Sooooo, it follows that the cancer was almost undoubtedly missed at least once and probably 2 or even 3 times. If the "new" guidelines go into effect, someone like me is much more likely to be at stage IV before the cancer is found.

I find it very sad that saving money is more important than saving lives.

voraciousreader · October 2011

gardengumby...I am sorry to hear about your diagnosis and how it was missed. Have you read the data from the studies? What you say," If the "new" guidelines go into effect, someone like me is much more likely to be at stage IV before the cancer is found" is contrary to what the data suggests.

gardengumby · October 2011

I haven't read the data itself, however I have read articles based upon the data (including the above quoted one). Assumptions are made - the primary one is that cancer is never "missed" in a screening mammogram (as it was for me - probably multiple times), which means that if a screening mammogram is done once every two years and missed, the odds of the cancer having progressed to stage IV by the time it is found is much greater. Even after my cancer was diagnosed, and I knew exactly where the invasive cancer was located, I couldn't feel it when doing a breast exam. I personally am certain the mammogram "saved my life", in that the cancer was found when it was in an early enough stage that it could be removed (along with my breast) before it metastasized.

Although advances have been made and stage IV cancer is "treatable" - treatable does not translate to "curable". My aunt lived with stage IV cancer for a number of years - quality of life should cound for something as well, and these articles do not include that consideration - it's simply are you alive or are you dead - and what are the odds you are going to die of something anyway within the timeframe when the cancer would take your life.

I personally find the articles that compare the costs of screening to numbers of people saved very troublesome.

Lolita · October 2011

My cancer was discovered by a mammogram early. I had a bilat. I might have gone for years with a slow growing cancer and might well have been over treated. We just can't distinguish which cancers will grow and which will not. This is where the money issue comes in. I would prefer that the funds that are going towards all of these unecessary mammograms go towards research into being able to distinguish types of cancer and for a real cure, whether it be a vaccine or some other targeted therapy. This would save more lives in the end.

voraciousreader · October 2011

For the record....my SCREENING mammogram missed my tumor and a DIAGNOSTIC sonogram found it. I had been going for SCREENING mammograms for the last dozen years, beginning at age 40, before being diagnosed. My ob/gyn found the lump at my annual check-up. My annual SCREENING mammogram and ultrasound would have followed a month or two after my annual ob/gyn check up.

Testimonials, like my own, DO NOT translate into fact. It's all about the collective data...

Fearless_One · October 2011

The money would be well-spent pursuing legislation to require insurance companies to start covering more reliable diagnostic tools such as MRI's. We have the technology to detect more BC's. We are being prevented from using it.

And I am aware of the "false positives" argument for MRI's. But that's better than a false negative - which is what I had 4 years in a row from my diagnostic mammos.

D4Hope · October 2011

I did self breast exams every month. I did not feel my tumor, my mammogram found it. My tumor was grade three and aggressive. I almost skipped that mammogram, imagine where I would be now if I did. I do not believe mammograms are uneccesary, no history of breast cancer in my family.

voraciousreader · October 2011

D4Hope...No one is saying that mammograms are unnecessary. The data is questioning how effective SCREENING mammograms are for certain populations and how frequently are they necessary.

xtine · October 2011

Argh... While this article may be factually correct, I hate when "value" is only measured by "lives saved". Early detection allows many women to avoid chemo or more extensive surgery. While these women might not have died from their cancer if it was detected later without mammogram, their lives certainly would be worse as a result of more aggressive treatment.

voraciousreader · October 2011

latimes.com

BOOSTER SHOTS: Oddities, musings and news from the health world

Screening mammograms save fewer lives than you think

By Karen Kaplan, Los Angeles Times/For the Booster Shots blog

3:37 PM PDT, October 24, 2011

If you or someone you know discovered she had breast cancer thanks to routine
mammography screening, and if you or that friend with breast cancer got
treatment and today is cancer-free, it's natural to assume that the mammogram
was a life-saver.

But odds are, it wasn't.

More likely, the cancer
that was picked up by that mammogram would have been just as treatable even if
it hadn't been caught until you or your friend felt a lump in the breast. It's
also entirely possible that the cancer wouldn't have killed you (or your friend)
if it had been left alone, untreated.

More than 75% of women who found
out they had breast cancer from a screening mammogram fell into one of these two
categories, and no more than 25% of them can give the test credit for saving
their lives.

So says a study published online Monday by Archives of
Internal Medicine. The authors - Dr. H. Gilbert Welch and Brittney A. Frankel of
the Dartmouth Institute for Health Policy and Clinical Practice - used data from
the National Cancer
Institute to arrive at this conclusion.

Their calculation depends on
two things. First, what is the probability that a mammogram will pick up a
breast cancer in a woman with no symptoms of the disease? Second, what is the
probability that the early diagnosis will allow that woman to beat a cancer that
otherwise would have been deadly?

The answers to both of those questions
depend on a woman's age, so the researchers ran the numbers for women at ages
40, 50, 60 and 70. The answer to the second question also depends on the degree
to which screening mammograms reduce the risk of death from breast cancer, so
the researchers used several different estimates ranging from 5% relative risk
reduction to 25%.

Let's consider the case of a 50-year-old woman in good
health with no family history of breast cancer:

Based on data from the
National Cancer Institute, we know that the probability that she will develop
breast cancer over the next 10 years is just under 3% (2,990 cases per 100,000
women). Among women of her age, 64% of those breast cancers are caught by
screening mammograms, so the probability that she will find out she has breast
cancer thanks to a mammogram is just under 2% (1,910 per 100,000
women).

The probability that a 50-year-old woman will die of breast
cancer over the next 20 years are slightly less than 1% (990 deaths per 100,000
women). But that figure is based on actual women (some of whom had their lives
saved or extended by screening mammograms) and would be higher if mammograms
didn't exist. If you assume that screening reduces the risk of death by 20%,
then the probability that a 50-year-old woman would die of breast cancer over
the next 20 years if she didn't have any mammograms rises to 1.24%
(1,240 deaths per 100,000 women). Simple subtraction suggests that screening
saves 250 lives per 100,000 women.

The researchers compared those 250
lives saved with the 1,910 women who discovered their breast cancers via
screening mammograms and calculated that the probability that our hypothetical
50-year-old owes her life to a mammogram are only 13% (250 divided by
1,910).

That rises to 17% if you give screening mammograms credit for
reducing the risk of breast cancer death by 25% instead of 20%. On the other
hand, if you assume that screening mammograms only reduce the risk of breast
cancer mortality by 5%, then the probability that a 50-year-old woman with
breast cancer had her life saved by the test falls to 3%.

The numbers
also change depending on a woman's age. In the analysis, screening mammograms
were most likely to save the lives of women who were 70. But even in that age
group, fewer than 25% of women whose cancers were caught by the test could
honestly say that it saved their lives, the researchers found.

Based on
the most recent data from large European studies, the benefit of screening
mammography is probably so low that the probability that the test will save a
woman's life is "likely to be well below 10%," the Welch and Frankel
write.

Yet any
suggestion that women get fewer mammograms is met with sharp
resistance from oncologists, radiologists and especially from breast cancer
survivors. The sheer numbers of breast cancer survivors has risen dramatically
in the last 40 years, with an estimated 2.5 million of them alive today.
Ironically, that success has helped reduce the rate at which screening
mammograms save lives - as more women are screened, the number of true success
stories is diluted by cases of women whose cancers would have been treatable
without screening or whose cancers would never have harmed them.

"This
self-reinforcing cycle ... is driven, in part, by the presumption that every
screen-detected breast cancer survivor has had her ‘life saved' because of
screening," the researchers write. "Our analyses suggest this is an
exaggeration. In fact, a woman with screen-detected breast cancer is
considerably more likely not to have benefited from screening. We believe that
this information is important to put cancer survivor stories in their proper
context."

The entire study is online here.

In
a commentary
that accompanies the study (but is behind a pay wall), two researchers from the
Minneapolis VA Center for Chronic Disease Outcomes Research and the University
of Minnesota endorse the counterintuitive findings. They acknowledge that when
cancers are discovered at an advanced stage, cure is a long shot. But that
doesn't necessarily mean that finding a cancer at the earliest stage is always
better.

"Patients and their clinicians assume that outcomes would be
worse if the condition were left undiagnosed and untreated, and survival is then
attributed to these interventions," write Dr. Timothy J. Wilt and Melissa R.
Partin. "However, longer survival times are poor predictors of the effectiveness
of treatment and more accurately reflect changing diagnostic methods."

pitanga · October 2011

The problem, as I see it, is that even if Dr. Welch is right that statistically speaking screening mammograms find more cancers that "do not require treatment" than ones that do, and thus "do not save many lives", in a statistical sense, what is the solution? To stop screening, in order to save the insurance companies money, and let those women who would have been helped die?

I do agree that the Pink Ribbon campaigns should not act like the only thing we need to worry about is making sure all women to be screened. We need better treatment too. But I don´t think that justifies abandoning screening.Until they come up with a better tool, I say stick with the mammograms. A person gets more radiation on an average airplane flight and we dont hear about people refusing to fly because of the unnecessary health risks.

My cancer first showed up when I was 39. It was stage 2, growing fast, and had already spread to my lymph nodes. I had a lumpectomy, lost all my lymph nodes, did chemo, radiation, tamoxifen, the works and 9 years later it still came back. Imagine if I had thought that mammograms were fro 50 year-olds, I would be long dead at this point.

1Athena1 · October 2011

I'm surprised at the hoopla about this article. It merely restates studies that have emerged in the past two years saying essentially the same thing: that mammography's role in saving lives is statistically insignificant and that almost as many women are harmed as saved. That does not negate the possibility that *you* or *I* may be harmed or saved. These studies are about large groups; they do not attemtp to capture individual experiences.

The role of screening in cancer generally is somewhat controversial. Never assume that, because your cancer was detected by any particular screening method, that screening method saved your life. It may or may not be true.

The role in diagnosing, as is pointed out earlier, is slightly different.

(FWIW: Mammography played no role in my case - good or bad. I felt my lump, a mammogram saw it clearly and so the the US, but the needle biopsy defined the mass as cancerous.)

pitanga · October 2011

Yes, Athena, I get the point about the statistical scale, but the problem is if they eliminate it and you happen to be one of the women whose life would have been saved, then you die. What can be said, statistically speaking that woman's life was not significant? Russian roulette, it was a gamble and she failed? To statisticians, no big deal, to her family, a huge tragedy.

If mammography is not good enough as a screening tool, they should work on developing another one, but in the meantime dont throw it out until something better is in place.

Lynn18 · October 2011

Why is whether or not a screening mammography saves lives the only issue considered? How about if a screening mammogram catches your cancer early enough to allow you to have a lumpectomy rather than a masectomy? Or allows you to treat your cancer with just radiation instead of aggressive chemotherapy? Aren't these also benefits of screening mammograms?

Furthermore, what about allowing us to decide for ourselves whether we want a mammogram annually? There are certainly individuals that are at higher risk. Don't take away our choices.

debbie6122 · October 2011

Pitanga- I agree with you, this is like playing russian roulette with our lives. And i think you are right on about the kick backs, Its all about the money.

I didnt feel a lump or thickning and was always checking my breast for lumps. went in for yearly mamo and it picked up all 4 lumps even showed the calcifacations, 3 were IDC and 1 was DCIS 2 of them were over 2 cm i had a large positive lymph node- Whos to say where i would be if it had not been caught, but im glad i didnt have to find out.

voraciousreader · October 2011

Lynn18....There is NO controversy regarding women at high risk. Those women are encouraged to get SCREENING regularly. The controversy is regarding women of average risk....which is the majority of women.....

Regarding aggressive or conservative treatment...THAT is also part of the controversy. They are questioning whether some women are receiving too aggressive therapy with screening mammograms that doesn't affect survival....

Regarding choice. Everyone should be able to make an informed decision with their doctor. However, when the doctors are receiving controversial information, how can they assist their patients in making an informed choice? THAT'S THE CONTROVERSY!

voraciousreader · October 2011

The distinguished British Medical Journal in it's October 25, 2011 issue discusses the controversy head on with an article written by the "Cancer Czar" of England. Below is his article. In a separate post below it, I will also paste the letter from the doctor that he received the request from to settle the controversy once and for all. I applaud the British for taking this bold step.

2011) Cite this as: BMJ 2011; 343:d6843