"Unthinking respect for authority is the greatest enemy of truth." (Albert Einstein, PhD, 1879-1955)

You may have heard of the latest mammogram study, published in the BMJ (formerly the British Medical Journal) on 11-Feb-2014, that was less than supportive of the general use of this medical procedure [1].

The study is the latest analysis, or follow-up report, of a long term study on mammography, the Canadian National Breast Screening Study (CNBSS) that commenced in 1980. None of the previous CNBSS follow-ups had been favorable to mammography either.

In summary, the latest rendition of the CNBSS [1] found no advantage in mortality reduction from the use of the test after 25 years over the administration of regular physical exams or routine care. Arguably worse, it found harm from mammography.

It is most crucial for the public to understand, and to keep in mind, that the CNBSS is merely ONE of many significant pieces of scientific evidence against the systematic use of mammography [2].

A Repeat Of The History Of Medical Politics

"Medical authorities, physician and patient groups, and 'experts' everywhere ignore science, and instead repeat history. Wishful conviction over scientific rigor; delusion over truth; form over substance." (David H. Newman, MD, in 2012)

As I had discussed in "The Mammogram Myth", the mammogram lobby and the medical orthodoxy have a long history of overlooking, denying, obfuscating, or misrepresenting genuinely meaningful evidence against the screening procedure.

This has now happened again. The age-old adage comes to mind, "history repeats itself"...

In accordance with that traditional pattern, firm defenders of the medical screening modality have surfaced almost immediately and scathingly criticized the new study. Within about a day of publication  of the CNBSS, one of the first such disagreements was issued by a prestigious Harvard professor of radiology, Daniel B. Kopans , MD in the response section to the BMJ study on 12-Feb-2014 [3].

Oddly, on the same day the American College of Radiology (ACR) and Society of Breast Imaging (SBI) also released a joint commentary on the latest CNBSS analysis on ACR's website [4], calling the study "incredibly flawed and misleading". No author was mentioned alongside the piece.

Yet, if you compare that scorching dismissal with Kopans BMJ commentary you will recognize that they are virtually the same.

Are the ACR/SBI the equivalent of Kopans? Is Kopans the ACR/SBI? (Kopans is currently on the board of directors of the SBI.)

I reckon it adds more authority and persuasive clout to an article if it is supposedly representing entire bodies of authority rather than just one single medical authority. It also helps to sway public opinion more convincingly and assuredly in the direction of the article's core message.

I've submitted a response to the editors of the BMJ addressing specifically Dr. Kopans' (or ACR/SBI's)

issues of contention with the new CNBSS follow-up, revealing fundamental misrepresentations on Kopans' (and ACR/SBI's) side. They've published it on 14-Feb-2014. You have free access to read my response, and Kopans original acerbic response to the CNBSS, on BMJ's website [3].
 

More Misrepresentations By Mammogram Authorities

"'Authorities,' 'disciples,' and 'schools' are the curse of science; and do more to interfere with the work of the scientific spirit than all its enemies." (Thomas H. Huxley, 1825-1895, Biologist)

Another very prominent, highly influential, authoritative longtime supporter of screening with mammography, László Tabár, MD (along with Tony Hsiu-Hsi Chen, PhD), also swiftly released a harsh rebuttal of the newest CNBSS update, calling the study "a total failure" and admonishing the public that "we do not want to go back to the Dark Ages of breast screening" [5]. A few days later, this practically exact same commentary was submitted by Tabár and posted by the editors of the BMJ on their website on 18-Feb-2014 [3].

Tabár's fundamentally baseless type of accusations against the CNBSS dovetail the views of Kopans, such as that the CNBSS researchers had resorted to old substandard mammogram machines, the administrators of mammography were untrained, and the purportedly inadequate randomization [5,3], much of which had been previously deflated by the CNBSS authors and other independent investigations (see references provided in my BMJ response [3]).

Tabár claimed in his critic that the CNBSS was previously "excluded from the meta-analysis of the impact of early detection using mammography on mortality from breast cancer by the World Health Organization's International Agency for Research on Cancer (IARC) workshop in 2002" because of methodological flaws [3,5].

This is not true as Cornelia J. Baines, MD, one of the co-authors of the CNBSS, denoted in her BMJ submission addressing Tabár's criticism on 19-Feb-2014 [3]. That particular IARC report [6] clearly stated "The Working Group concluded that these trials [=CNBSS] were valid [...]" (explanation added). The CNBSS got eliminated because it had DIFFERENCES in study design compared to the other trials, rather than because of FLAWS in methodology.

Tabár, like Kopans, has enormous vested interests (or conflicts-of-interests) regarding mammography [2,7]. And like Kopans, Tabár totally misrepresents his commercially-conflicted position by publicly declaring to have no "competing interests" in his response submission to the BMJ on 18-Feb-2014 [3]. And, Tabár and many other pro-mammogram investigators afflicted by conflict-of-interests have made this abysmal misrepresentation in other research papers [2].There are people who call that outright lying.

If someone gives the appearance of acting altruistically in your interests but has massive personal business interests tied to the recommendations divulged to you and denies they exist, do you still trust the person's advice? Are these acts of omission or misrepresentation proof that these mammogram authorities are dedicated for women to know the truth about the screening test? How do you know which information they promulgate is truthful, and which isn't?

In a video clip on Tabár's official website, named 'Dr. Tabar and Colleagues Discuss Canadian Study: What Should I Know About The Canadian National Breast Screening Study', he emphatically stated about the latest results of Miller and colleagues [1], "[...] women should take home one message: go for a mammogram, [...], and don't listen to anything that is concluded from this terrible Canadian trial." [8].

Evidently, "what you should NOT know" is that Tabár has a vast commercial interest in continuously pushing women to have mammograms.

In nations dominated by big corporate self-interests such as the US, it's not what the mammogram industry, and the mainstream medical establishment in general (and their loyal disciples), tell you about their procedures or products that you primarily should be concerned about but what they do NOT tell you - such as that they are the biggest profiteers of these medical tests, treatments and interventions, or that meaningful evidence invalidates their claims of value, or the purported absence or insignificance of risk, of their medical "wares".

For instance, other pertinent information Tabár isn't disclosing (or what you should not know?) is that his own extensive mammogram study, the Swedish Two-County trial, which he depicted favorably in his BMJ commentary [3], was shown to be seriously flawed [9,10]. Tabár stated that a comparison between the Canadian trial [1] and the Two-County trial is "inappropriate" because (among other reasons) "The Swedish Trial has accomplished a significant decrease in mortality from breast cancer, the Canadian trials did not!" [3]. Yet, Per-Henrik Zahl, MD, PhD, an independent mammogram researcher, had demonstrated that many deaths were missing in the Two-County trial, concluding that the study is "seriously flawed" [10].

CNBSS co-author Baines had pointed out other methodological weaknesses of the the Swedish Two-County trial compared to the Canadian trial in her rebuttal response at the BMJ on 19-Feb-2014 and a few years prior already, namely lesser compliance, lower frequency of screening, a lower cancer detection rate, and of the use of only "single-view mammography" [3,11].

Tabár made the remark that "The Canadian trials stand apart as the only ones among the published screening trials that failed to show any effect on mortality from breast cancer." [3,5]. However, the re-analysis of his Two-County study by the Nyström group found a statistically insignificant reduction in breast cancer mortality in women ages 40-49 [9].

On what scientific grounds does Tabár slander another study on the sort of issues his own investigation had been accused of, and then make it appear as if his own study was well-designed and highly valid compared to it [11]?

Furthermore, few people, like few traditional doctors, are aware that several mammography-favorable studies, officially deemed and propagated by the mammogram-medical industry as highly relevant and of meticulous design, are actually seriously flawed [2].

Are We Still In The Dark Ages Of Breast Screening?

"[...] there is a distinct herd instinct among people who "work in science," which makes it easy to believe whatever sounds plausible, if a lot of other people are saying it is true." (Ray Peat, PhD, Biologist, in 2008)

The most reliable manifestation that we still ARE "back in the Dark Ages of breast screening" is the unending suppression and manipulation of the real facts of mammography by its biggest profiteers, ranging from radiologists, oncologists, surgeons, media doctors, medical associations, mammogram equipment companies, the medical industry-sponsored mass media, to various charities of the pink ribbon movement. And, that the most frequent, loudest, and most vicious ad hominem attacks and derisions against mammogram dissenters come from these camps [2].

In today's times of global corporate hegemony and corporatism, creating "a time of universal deceit" to quote George Orwell (1903-1950),  the acquisition of the real truth ever increasingly demands for the public to carefully scrutinize whether ANY particular person or organization spreads the true facts, rather than to rely on whether the entity enjoys an esteemed popular reputation and has impressive official credentials. Understandably, the former orientation requires (more) personal effort. But, "in a time of universal deceit", the discovery of the actual truth is challenging so that individual pro-activity attains the status of great urgency.

The arguably only and best time-tested fact is that the advocacy of mammography is primarily and practically exclusively supported and defended by medical dogma, flawed studies, misleading claims, distortions, or concepts (such as "survival times"), gigantic vested interests, system justification, and profound politics (extending to the federal level), instead of sound relevant science [2].

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] Hefti R, "The Mammogram Myth: The Independent Investigation Of Mammography The Medical Profession Doesn't Want You To Know About", (e)Book, 2013 (Available at Amazon, Apple, Barnes & Noble, Smashwords, etc.)

[3] http://www.bmj.com/content/348/bmj.g366?tab=responses [accessed 19-Feb-2014]

[4] http://www.acr.org/News-Publications/News/News-Articles/2014/ACR/BMJ-Article-on-Breast-Cancer-Screening-Effectiveness-Incredibly-Flawed-and-Misleading [accessed 14-Feb-2014]

[5] Tabàr L, Chen TH, "We do not want to go back to the Dark Ages of breast screening", http://www.auntminnie.com, 12-Feb-2014

[6] Vainio H, Bianchini F (Editors), "IARC Handbooks of Cancer Prevention, Volume 7: Breast Cancer Screening", IARC Press, Lyon, 2002

[7] Riva C, Biollaz J, Foucras P, Junod B, Nicot P, Spinosa JP, "Effect of population-based screening on breast cancer mortality", Lancet. 2012 Apr 7;379(9823):1296; author reply 1298.

[8] http://www.mammographyed.com [accessed 19-Feb-2014]

[9] Nyström L, Andersson I, Bjurstam N, Frisell J, Nordenskjöld B, Rutqvist LE, "Long-term effects of mammography screening: updated overview of the Swedish randomised trials", Lancet. 2002 Mar 16;359(9310):909-19.

[10] Zahl PH, Gøtzsche PC, Andersen JM, Maehlen J, "Results of the Two-County trial of mammography screening are not compatible with contemporaneous official Swedish breast cancer statistics", Dan Med Bull. 2006 Nov;53(4):438-40.

[11] Baines CJ, "Rational and irrational issues in breast cancer screening", Cancers (Basel). 2011 Jan 11;3(1):252-66.
 

Copyright © 2014 by Rolf Hefti. This article has been written exclusively for http://www.greenmedinfo.com. Permission to reproduce in whole or in part is gladly granted, provided full credit and a live link are given.