Take a look at the 15 or so 'rapid responses' to the original article, available free from the British Medical Journal. Radiologist Daniel Kopans from Harvard gives some history and mentions the study coordinators who compromised randomization by placing women with breast concerns in the screening group! He also confirms their use of second hand machines along with poor technologist training.  

Another doctor, Albert Einstein's Patrick Borgen stated that major media markets reported these results as a valid challenge to the routine use of mammography which it is NOT (emphasis added). In addition, he described the New York Times presentation as completely unbalanced "the height of irresponsibility".

Regarding Dr Kopans....Dr. Kopans has been the leading voice among radiologists who sharply disagree with those who are in the "camp" that believe screening mammograms save fewer lives.  Below is a point of view of the ebook author of The Mammogram Myth, who IMHO lays out well this current debate with respect to Dr.Kopan's position. As I have said, I've grown weary of this debate.  Over the years, as I read the details of the opposing sides, I've become very familiar with most of the debate "players" who include Dr. Kopans.....

This is included among the BMJ's rapid responses:

________________________________________________________________________________

Re: Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial

14 February 2014

Dr. Daniel B. Kopans' claim of lack of proper randomization in the trial by Miller, et al., 2014 [1] in his response on 12-Feb-2014 is based on a paper from 1995 [2] which found more participants in the screening arm had invasive breast cancer at the start of the longterm study by Miller, et al., 2014 [1]. This bias, Kopans countered, would result in "more early deaths among the screened women than the control women", diminishing the value of mammography. Other researchers, however, were unable to verify the group allocation lapse in the work of Miller and collaborators, a specific criticism promulgated frequently by Kopans and others [3,4].

Moreover, Miller, et al., 2014, explained in their most recent study paper that "if" there was a bias in randomization at the start of the trial, "the bias would only impact on the results from breast cancers diagnosed during the first round of screening" [1] as these existing excess cancers would have been detected upon the initial or following screening, in a study that went through many screenings and lasted for over twenty years and, therefore, would not affect the results found in their latest follow-up study. Furthermore, Miller, et al., 2014 pointed out that even after this excess of incurable breast cancer is removed from the mortality analysis of the screened participants "the data do not support a benefit for mammography screening" [1].

Why didn't Kopans mention this crucial set of information in his vehement dismissal of the trial by Miller, et al., 2014 which he equates to a paper portraying a "suspect" analysis of results and "corrupted results"? Doesn't this omission indicate bias on Kopans' side, thus resulting in a display of "corrupted results" and a "suspect" commentary? It can hardly be explained by Kopans' failure to read the actual study of Miller and colleagues as he cites and refers to specific details from their paper.

Much of the criticism brought forward by Kopans had been addressed and refuted in earlier papers by Miller and colleagues [5,6] yet Kopans and others keep resorting to the same, or similar, misleading allegations.

In a prior paper of Kopans [7] he stated that the excess of breast cancer mortality, an outcome of the purported biased group allocation of individuals with invasive cancer upon trial commencement, was still apparent after ten years in the screened group of the longterm study lead by Dr. Anthony B. Miller. If this is the case it suggests screening with mammography fails to effectively detect incurable lethal cancers (but rather finds many non-cancers via overdiagnosis).

In his response, Kopans attributes the "extremely low" breast cancer detection percentage of 32%, reported in the latest analysis by the Miller group, to poor administration of the mammogram procedure, leading to missed cancers. Instead, Kopans claims, "at least two thirds of the cancers should be detected by mammography alone" based on a 2010 study he cites. However, another investigation, using data derived during the 1990s thus more consistent with the study time-frame of the Canadian trial, denoted a cancer detection of 29% by mammography alone [8].

Kopans describes in his critique how the low detection of breast cancer in the study by Miller, et al., 2014 is a sign of "the poor quality of the mammography" implementation of that study, pertaining to allegedly the use of "second hand" old mammographic equipment and the improper application of the procedure although the Miller team denoted that "the screening examination was properly conducted". The newer mammogram technology of today leads to a higher detection rate [9,10] but also elevates the magnitude of overdiagnosis, increasing the serious unnecessary harm to women via overtreatment. The extent of overdiagnosis from mammography was shown to be both large and significant [11-13].

Most of the mammogram studies showing a significant benefit are also older, having used old mammogram machines. Does the old technology argument only carry validity and relevance to adherents of mammography when a study doesn't find any meaningful value with screening? Some people would call that bias.

Kopans belittles an alleged previous notion of the study's [1] "principal investigator" -that is, the squeezing motion of the mammogram procedure can promote the influx and growth of cancer cells, leading to early deaths- as "nonsense" and a "completely unsupportable theory" with "no scientific basis". Yet, robust scientific data, published in prestigious medical journals, have lent meaningful support to the concept [14-16].

Kopans declared that he has no competing interests in his response comment but he is one of the principal developers of breast tomosynthesis, a digital form of mammography, and an inventor and patent holder (U.S. Patent No. 7,356,113) of a commercial digital breast tomosynthesis system [17,18]. Kopans also has not declared competing interests in other studies he co-authored promoting the value of his digital breast tomosynthesis system [19,20].

In my own personal, rather exhaustive, investigation of the value of mammography I have encountered numerous instances of omission, denial, derision, and obfuscation of genuinely relevant scientific data by the supporters of screening with mammography, shifting the "evidence" artificially in favor of the procedure. As a result, the general public and particularly women who decide to subject themselves to mammography, unfortunately, have been hampered from making an "informed choice" about this controversial test.

References:

1. Miller AB, Wall C, Baines CJ, Sun P, To T, Narod SA, "Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial", BMJ. 2014 Feb 11;348:g366. doi: 10.1136/bmj.g366.

2. Tarone RE, "The excess of patients with advanced breast cancer in young women screened with mammography in the Canadian National Breast Screening Study", Cancer. 1995 Feb 15;75(4):997-1003.

3. Cohen MM, Kaufert PA, MacWilliam L, Tate RB, "Using an alternative data source to examine randomization in the Canadian National Breast Screening Study", J Clin Epidemiol. 1996 Sep;49(9):1039-44.

4. Bailar JC 3rd, MacMahon B, "Randomization in the Canadian National Breast Screening Study: a review for evidence of subversion", CMAJ. 1997 Jan 15;156(2):193-9.

5. Baines CJ, "The Canadian National Breast Screening Study: a perspective on criticisms", Ann Intern Med. 1994 Feb 15;120(4):326-34.

6. Miller AB, To T, Baines CJ, Wall C, "Canadian National Breast Screening Study-2: 13-year results of a randomized trial in women aged 50-59 years", J Natl Cancer Inst. 2000 Sep 20;92(18):1490-9.

7. Kopans DB, "Canadian National Breast Screening Study", Lancet. 1997 Sep 13;350(9080):810.

8. Sener SF, Winchester DJ, Winchester DP, Kurek R, Motykie G, Martz CH, Rabbitt S, "Spectrum of mammographically detected breast cancers", Am Surg. 1999 Aug;65(8):731-5; discussion 735-6.

9. Hambly NM, McNicholas MM, Phelan N, Hargaden GC, O'Doherty A, Flanagan FL, “Comparison of digital mammography and screen-film mammography in breast cancer screening: a review in the Irish breast screening program”, AJR Am J Roentgenol. 2009 Oct;193(4):1010-8.

10. Nederend J, Duijm LE, Louwman MW, Groenewoud JH, Donkers-van Rossum AB, Voogd AC, "Impact of transition from analog screening mammography to digital screening mammography on screening outcome in The Netherlands: a population-based study", Ann Oncol. 2012 Dec;23(12):3098-103. doi: 10.1093/annonc/mds146. Epub 2012 Jun 27.

11. Jørgensen KJ, Zahl PH, Gøtzsche PC, “Overdiagnosis in organised mammography screening in Denmark. A comparative study”, BMC Womens Health. 2009 Dec 22;9:36

12. Gøtzsche PC, Nielsen M, “Screening for breast cancer with mammography.”, Cochrane Database Syst Rev. 2011 Jan 19;(1):CD001877.

13. Bleyer A, Welch HG, "Effect of three decades of screening mammography on breast-cancer incidence", N Engl J Med. 2012 Nov 22;367(21):1998-2005.

14. van Netten JP, Mogentale T, Smith MJ, Fletcher C, Coy P, “Physical trauma and breast cancer”, Lancet. 1994 Apr 16;343(8903):978-9.

15. van Netten JP, Cann SA, Glover DW, "Mammographic compression: a force to be reckoned with", Br J Cancer. 1999 Dec;81(8):1426.

16. Abramovitch R, Marikovsky M, Meir G, Neeman M, "Stimulation of tumour growth by wound-derived growth factors", Br J Cancer. 1999 Mar;79(9-10):1392-8.

17. Chan HP, Wei J, Sahiner B, Rafferty EA, Wu T, Roubidoux MA, Moore RH, Kopans DB, Hadjiiski LM, Helvie MA, "Computer-aided detection system for breast masses on digital tomosynthesis mammograms: preliminary experience", Radiology. 2005 Dec;237(3):1075-80. Epub 2005 Oct 19.

18. Acciavatti RJ, Maidment AD, "Oblique reconstructions in tomosynthesis. II. Super-resolution", Med Phys. 2013 Nov;40(11):111912. doi: 10.1118/1.4819942.

19. Chan HP, Wei J, Zhang Y, Helvie MA, Moore RH, Sahiner B, Hadjiiski L, Kopans DB, "Computer-aided detection of masses in digital tomosynthesis mammography: comparison of three approaches", Med Phys. 2008 Sep;35(9):4087-95.

20. Chan HP, Wei J, Sahiner B, Rafferty EA, Wu T, Roubidoux MA, Moore RH, Kopans DB, Hadjiiski LM, Helvie MA, "Computer-aided detection system for breast masses on digital tomosynthesis mammograms: preliminary experience", Radiology. 2005 Dec;237(3):1075-80. Epub 2005 Oct 19.

Competing interests: Author of the (e)book "The Mammogram Myth"

I agree with you Voracious.....EXCEPT - From what i see, it IS what is being debated, the fact that mammograms saves lives.  I felt attacked on the NPR Diane Rehms link i posted in my post above.....for making that exact statement.  While before my cancer dx I was not a fan of getting mammograms because they are not perfect......getting dx on my FIRST mammogram, and having an early dx, changed my mind quickly and yes I stand by my statement that it DID save my life, because I know I never would have gotten one had I not have several friends dx with BC.

I also agree with the article about the flaws in the study about the 2nd hand mammo machines......were they not even up to par with what they are using now, and arent the machines now using LESS radiation?  Maybe that's just a side note......

Studies like this, I feel, undermine young women to get mammograms.......

Shayne....the mammography debate is a nuanced one and sisters shouldn't attack one another since we are all in the same trench.  That said, none of us can claim with certainty that a population based mammogram saved our lives.  For sure, patients aged 50-69 who have screening mammos derive the MOST benefit. Recall the 2009 Task Force recommended screening for that age group every two or three years and health practitioner, politicians and patients balked, so the recommendation was sidelined.

Now, with respect to you, if you were less than 50 before you decided to be screened and that first mammo found an aggressive tumor, then YES, it's likely that that mammo saved your life.  But unfortunately for many women between 40-49, screening mammos are less effective at spotting cancers due to breast density. And for even younger women, it's even tougher to spot.  According to the data, younger women diagnosed with breast cancer are usually diagnosed because they are symptomatic and receive DIAGNOSTIC mammograms and THOSE mammograms save lives,  many lives and there is NO debate about their importance.

However, here's the debate in a nutshell.  If you are 50 and decide it's time for a SCREENING mammo and you have it done, there are three possibilities. The first,  where cancer is found, the second is DCIS or third, you are normal.  There's also a forth, you are called back for something suspicious, but you end up in one of the previous three categories...Now, if you are "lucky" and the screening mammo picked up the tumor, then you can say, "That screening mammo saved my life.". But, you really don't know with certainty that it saved your life until you die from something else.  It's more possible, if it was an aggressive tumor that it LIKELY saved your life.  Now here's where it gets tricky...If it was an indolent cancer, it probably could have been diagnosed once you were symptomatic and a DIAGNOSTIC mammogram would have found it and whether it was found early or later, it didn't matter in the long run because treatments are so good.  But say you had that screening mammo in January at age 50 and it was clean.  Six months later you feel a lump and get that diagnostic mammo and find out you have cancer. Since it wasn't seen six months before on the screening mammo, it is likely to be an aggressive tumor and hopefully it will respond to treatment.  

So, Shayne, do you see where the controversy is?  Dr. Kopans and his "camp" would like us all to believe that anyone from age 40-69, needs a screening mammo every year, while Dr. Miller as well as Dr. Welch are saying, not so fast.....

If you believe that that first screening mammo saved your life, that's okay.  But I hope you understand what this debate is truly about and that is, screening mammos save lives, but no one is precisely sure how many!  To me, when I hear someone say their life has been saved by a screening mammo, I'm genuinely happy for them.  As for me, as long as this debate rages, when someone tells me or I have read about a screening mammo saving a life, in the back of my mind I'm really thinking it's magical thinking and when we collectively feel that way, then I think it hinders us from finding a better way of screening....

Do I think this debate will hinder YOUNGER women from stepping up to the plate and getting that first mammo?  It might.  But those YOUNGER women should know they are the ones who might benefit less from having that mammo.  They deserve to know the limitations of screening mammos.  They should be the ones to jump up and say,"Settle this debate or find another way to screen us!". 

I noticed awhile back on this thread, how much radiation you get from a mammogram was mentioned. It was explained to me that it varies. Since my breast were dense & wouldn't compress, I had to stay in the vice longer because I needed a longer exposure. Even at the "screening" mammograms I received, they often had to redo the pictures. I also started getting mammograms at age 30. Not sure why. My only risk factor was not having a child yet. All mammograms show in younger women like me is dense breasts, so they would probably miss most cancers. My mammogram reports mentioned that, but still I was told to get another one every year. I did so for 22years! As far as radiation exposure, I'm sure 22yrs worth of mammograms is a drop in the bucket compared to what I received with bilat RADs. I didn't have the patience to use the radiation exposure calculator posted earlier in this thread.

I read Dr Brawley's book awhile back. I'm even less of a mammogram fan. But I do agree we have become too complacent. 

Also, please keep in mind that with the new digital mammograms, a CAD program alerts the radiologist to irregularities that might escape the notice of a human. My tumor was identified as an architectural distortion by this program.  Also, the new 3-D mammos find more bad stuff along with fewer fase positives.  Anyone with dense breasts might want to make the effort to seek out a hospital that has this new imaging.

I finally found what Dr. Welch has to say:

Editor's note: H. Gilbert Welch is a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and author of "Should I Be Tested for Cancer? Maybe Not and Here's Why" (University of California Press) and co-author of "Overdiagnosed: Making People Sick in the Pursuit of Health."

(CNN) -- We all like to think medical care is about science, but too often it's about professional interests.

Last week, a 25-year follow-up of the Canadian National Breast Screening Study was published -- one of the eight major randomized trials of screening mammography. The headline was simple: Mammogram screenings don't reduce cancer death rates.

The reaction by some American mammographers was predictable -- discredit the study. It's predictable because it is exactly what they did when they didn't like the first findings of the study published more than 20 years ago.

The effort by the American College of Radiology to discredit the Canadian trial relies on two allegations:

H. Gilbert Welch

The investigators were cheating: Let's look at the background on this. Randomized trials are a critical tool for clinical researchers. Study participants are placed at random in either one group (in this case those who get mammograms) or the other (those who do not). Who is in which group is solely based on the play of chance -- a flip of a coin.

The allegation of cheating -- purposely putting women whom researchers knew had advanced cancers in the mammography group -- is an incredibly serious one. It sure was taken seriously by Canada's National Cancer Institute. It launched a two-year independent review of the entire randomization process. In 1997, the review found no credible evidence of cheating.

But that didn't stop the allegation from being trotted out last week. The new study provides evidence that randomization did exactly what it is supposed to do: It created two identical groups of women. The rate of death in the two groups was exactly the same, every year, for 25 years. That can't happen by cheating -- that can only happen when the groups are....

http://www.cnn.com/2014/02/19/opinion/welch-mammograms-canada/

I found this comment following Dr. Weiss's column that tickled my brain:

"This "flawed" study excuse. I hear this term used when people dont agree with a study. What confuses me is that these studies are all peered reviewed and often published in established journals. Why were the flaws not found in the review?"

IMHO, this is an extremely powerful statement!  The BMJ is considered among the best medical journals in the world.  The point made by the above commenter is important with respect to how do studies make their way into journals.  Going back in time, the Vioxx debacle led to changes in how studies can now be accepted into journals.  If a study's researcher has any connection to a vested interest, they must disclose that interest.  How a study was funded must also be disclosed.  Studies also must be "peer reviewed."  Now that can become a hornet's nest.  Who EXACTLY did the peer review for all of these "questionable" studies?  I've often wondered about that point.  If the "peers" that  "review" studies have their own biases, then can we "believe" the study?

Getting a study into a leading journal has become more difficult since the Vioxx debacle.  And yet, "questionable" studies, such as the seminal study published in 1998 regarding autism and vaccines was, twelve years later, rebuked and retracted from The Lancet.

I think the Mammography debate has just jumped the shark and become a war.  Very.Very.Sad.

 I am so confused about this whole thing. Truly. What would you ladies do to protect your daughter if she was at high risk? Mine is only 24 right not, and I think too early to get on the screening train, though my mom had BC at 27. (I'm Brca neg.)

Yes yes yes - how I welcome better screening options. Speaking of the blood test - my Genetic Doc is involved in research for that. I think I'll see if I am eligible to enroll.

http://www.breastmrioklahoma.com/research.asp

So now I'm looking for studies that show that mammograms do save lives, and I'm really not finding much. Just studies similar to the one that started this thread like this one: http://www.nejm.org/doi/full/10.1056/NEJMoa120680...

And this one: http://summaries.cochrane.org/CD001877/screening-...

It just seems counterintuitive that catching cancer earlier wouldn't reduce mortality rates down the line. But it seems like a huge expense (aggregately) with not much return.

I do hope effective blood tests become the standard soon. 

The other thing I hope is women with dense breast tissue will be able to skip the mammograms and just have ultrasound, which seems much more effective in finding their cancers. http://www.ncbi.nlm.nih.gov/pubmed/24471386

Shayne....This "war" isn't about whether or not one should have a mammogram.  So there should be no struggle with the decision to have one.  This "war" is over whether or not population based mammograms save lives.  What the biostatisticians are saying is everyone should know their risk factors for breast cancer and based on their risk factors and age should then know how often they need a mammogram. 

And yes, emotional issues should be factored into the equation of how often one should be screened.  Don't lament about your upcoming mammogram appointment.  As the Queen would say, "Keep calm and carry on."  I wish you well!

All studies are flawed by nature and if that is the only thing I acquired from my university course on statistics, then I gained more than I realized at the time.  When I mentioned this study (Mammograms do not save lives), my specialist responded with, "do not get me started!"  He then went on to state that instead of studying numbers, perhaps researchers would like to meet his patients in person.  He wants to introduce them to the ladies with ulcerated breasts from breast cancer that never had a mammogram.  I respect research and recognize it's value, but equally recognize its limitations.

TB... The study does NOT say... Mammograms Do Not Save Lives!  It says it doesn't save as many lives as we think they should.  The argument is about moving away from population based mammography.

And with respect to ulcerated breasts because women haven't had a mammogram... Dr. Otis Brawley, the chief medical officer for The American Cancer Society addresses that fact in the first paragraph of his excellent book, How We Do Harm.  Perhaps you and your physician should read the book, if you haven't already.

Dr. Brawley does an excellent job of explaining why that occurs!  And it has nothing to do with the mantra that Mammograms Save Lives!  Sadly, that has to do with the unhealthy state of how we ALL go about receiving healthcare.  More healthcare doesn't necessarily mean better AND not having access to healthcare or the wherewithal to getting it IS a real issue!  The woman in his book, came into the hospital with her breast in a garbage bag!  She worked hard to support her family and wasn't given the time off from work or family responsibilities to seek medical attention.