Presentation on websites of possible benefits and harms from screening for breast cancer: cross sectional study
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7432.148 (Published 15 January 2004) Cite this as: BMJ 2004;328:148All rapid responses
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Breast Cancer Care believes the article raises some interesting
issues and contributes to the ongoing debate on screening. However we
strongly disagree with the statement that implies that we 'accept industry
funding, apparently without restrictions'.
Breast Cancer Care has to fundraise in order to provide services for
anyone affected by breast cancer. Our commitment to service users is of
paramount importance to us and therefore we are very selective about those
companies from whom we will accept sponsorship. We are open about the
sponsorship we receive from companies, such as Boots and Novartis, but
under no circumstance is any aspect of our work, including our website,
influenced by any company.
Competing interests:
None declared
Competing interests: No competing interests
Yawn - yet another "infodemiology" [1] study. This must be study #346 with the message "we searched information about [plug-in-your-topic-here] on the web and found that information on [plug-in-your-topic-here] is poor".
Amazing that the BMJ is still publishing these kinds of studies.
Also interesting is that authors affiliated with a Cochrane Centre fail to cite (or be aware of it) a relevant systematic review [2] which could have informed methods and discussion of this study.
Some investigators still evaluate websites as if they were "information pamphlets". To evaluate the "comprehensiveness" of a printed pamphlet (where it can be assumed the patient is not using anything else) may make sense, but to evaluate a website under the aspect of completeness does not take into account that people are usually gathering information from different websites [3].
References
1. Eysenbach G. Infodemiology: The Epidemiology of (Mis)information. Am J Med 2002; 113: 763-765.
[Medline]
2. Eysenbach G, Powell J, Kuss O, Sa ER. Empirical studies assessing the quality of health information for consumers on the world wide web: a systematic review. JAMA 2002; 287: 2691-2700.
[Abstract]
3. Eysenbach G, Köhler C. How do consumers search for and appraise health information on the World-Wide-Web? Qualitative study using focus groups, usability tests and in-depth interviews. BMJ 2002; 324: 573-577.
[Full text]
Competing interests:
None declared
Competing interests: No competing interests
First and for most I would like to thank the authors Jorgensen and
Gotzsche for exploring the relationship between corporate funding and
health information presentation and dissemination. As an organization
dedicated to providing a critical analysis of women’s health issues, The
National Women’s Health Network recognizes the significant influence such
funding can have over those who provide consumers and policy makers with
health information.
That being said, I would like to offer a comment and correction on
how the NWHN was categorized within the study. The authors placed us
within the advocacy group category (“general purpose is to promote the
interests of patients and their relatives”)while it is true that we are an
advocacy group, we are also a consumer group (“general aim is to assess
the quality of the health care services that are offered to patients and
citizens”). I recognize that we are something of a hybrid and can be
difficult to categorize. I am concerned however that the authors stated
that all 13 advocacy groups included in the study accepted industry
funding. The National Women’s Health Network has maintained a strict “no
industry” funding policy since its inception in 1975. This policy has
allowed NWHN to remain independent, and has earned us a reputation as one
of the few organizations that provides accurate and reliable information
on women’s health, free from industry influence.
Competing interests:
None declared
Competing interests: No competing interests
It is ironic that a paper purporting to reveal ‘bias’ in government
and advocacy websites providing information on mammographic screening
should itself be a prime example of both ‘bias’ and misleading
information. Language may be as purposively misleading as statistics – why
else do Jorgensen and Goetzsche repeatedly use the term ‘harms’ when
discussing the risks associated with mammography? Is it coincidence that
these authors, with their own personal axe to grind are the only
researchers of note to resort to such language? Nor do they mention the
‘fact’ that the Cochrane Collaboration has consistently rejected their
previous findings. So much for ‘balanced information’ and informed
consent! But what is most disappointing about this publication is that the
BMJ has allowed itself to become party to another attack on mammography
whilst parading the paper as ‘research’ on website quality.
Competing interests:
None declared
Competing interests: No competing interests
Sir,
I agree certainly with the authors’ statement “The information material
provided by professional advocacy groups and governmental organisations is
information poor and severely biased in favour of screening” (1).
Unfortunately, they do not consider, or perhaps ignore, another reason of
paramount relevance. It is to say that they take no notice of the
significant developments of physical semeiotics occurred over the last
five decades (See the website HONCode 233736, www.semeioticabiofisica.it),
particularly as breast cancer primary prevention, and clinical diagnosis
are concerned (2). In fact, in "all" cancer screening we must, first of
all, carefully recognize and, then, select, at the bed side, all
individuals at “real” risk of malignancy, but not other people without
such as predisposition(2,3,4,5). That is, also these authors do not know
the real existence and, consequently, they can not assess the seriousness
as well as the precise location of a particular mitochondrial
cytopathology, Congenital Acidosic Enzyme-Metabolic Histangiopathy,
“Oncological Terrain” is based on (2,3,4 5). For instance, considering the
well-known negative influence of oral contraceptive use on breast and/or
ovary oncogenesis, and/or arterial disorders, we have firstly to take into
account the importance of the genetic predisposition, now-a-days perfectly
evaluated clinically in a “quantitative” way (See “Biophysical
Constitutions” in above-cited website), as far as the onset of a large
number of disorders is concerned, including solid as well as liquid
malignancies. In fact, without the Oncological Terrain, i.e., the
remarkable functional abnormality of psycho-neuro-endocrine-immunological
system, oncogenesis is not possible at all, and consequently mammography
is useless, a part from its negative side-effects, different in origin.
Therefore, in oncological medicine, all around the world, the importance
of the above-mentioned congenital mitochondrial cytopatology, and
Oncological Terrain, should not be overlooked, particularly when we
perform cancer screening programme.
1) Jørgensen KJ., GøtzschePC. Presentation on websites of possible benefits and harms from screening for breast cancer: cross sectional study BMJ 2004;328:148 (17 January), doi:10.1136/bmj.328.7432.148.
2) Stagnaro-Neri M., Stagnaro S., Cancro della mammella: prevenzione
primaria e diagnosi precoce con la percussione ascoltata. Gazz. Med. It. –
Arch. Sc. Med. 152, 447, 1993
3) Stagnaro S., Auscultatory percussion of the cerebral tumour: Diagnostic
importance of the evoked potentials, Biol. Med., 7, 171-175 1985
4) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica
condizione necessaria non sufficiente della oncogenesi. XI Congr. Naz.
Soc. It. di Microangiologia e Microcircolaz. Abstracts, pg 38, 28
Settembre-1 Ottobre, 1983, Bellagio.
5) Stagnaro-Neri M., Stagnaro S. Introduzione alla Semeiotica Biofisica.
Il Terreno Oncologico. Travel Factory, Rome, in press.
Competing interests:
None declared
Competing interests: No competing interests
Breast cancer screening and radiation risk
The wide-ranging and informative review of screening mammography(Juhl
& Gotzsche, 17Jan)identifies corporate contributions as a determining
factor in program and policy development by some breast cancer advocacy
groups. Since non-profit nongovernmental organizations(NGOs)always are
strapped for funds, corporations have found a fertile field for their
"greenwashing" tactics. When non-profits take these monies they accept
the corporate ethic that places profits above the public health, safety
and welfare. In fact, some of their leaders have gone through the
revolving door into the corporate sanctum sanctorum where they reach for
The Golden Ring(1) while others act as surrogates for industry on federal
agency advisory boards(2).
The authors never mention the potential health risks from radiation,
particularly when breast screening begins at age 40, as strongly
recommended by the American Cancer Society and the National Cancer
Institute(NCI), and you seldom see dose referenced(0.2-0.8rad, including
retakes). The historical review, PREVENTING BREAST CANCER: THE STORY OF A
MAJOR, PROVEN, PREVENTABLE CAUSE OF THIS DISEASE, by John W. Gofman,
former associate director of Lawrence Livermore National Laboratory, lists
27 studies that quantify cancer induction linked to radiation(3).
Cumulative dose should be a cause for concern as numerous studies now
demonstrate there is no safe dose(threshold). Future screening studies
should deal forthrightly with issues relating to x-ray dose and
risk/benefit, indicating this information must be communicated to patients
as required by the Nuremberg Code and the Helsinki Accords.
References
1. Ehrle LH. Partnerships between universities and
industry (letter). JAMA 2002;287:1398-1399.
2. Egilman DS, Ehrle LH. Handling conflicts of interest
between industry and academia. JAMA2003;289:3240-3241.
3. Gofman JW. Preventing Breast Cancer: The Story of a
Major, Proven, Preventable Cause of This Disease.
San Francisco: Committee for Nuclear Responsibility
Books, 1996(2nd ed).
Competing interests:
None declared
Competing interests: No competing interests