By now, you must be aware of the Canadian mammography study that appeared in the BMJ last week. It found that “Annual [screening] mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available.” And there was an associated risk of overdiagnosis.
It was a randomized prospective trial involving almost 90,000 women over a 25-year period. The full text is here.
Just about everyone, supporter or critic, has weighed in with an opinion about the paper. Here’s a different take.
Earlier this month, I gave a talk at the Academic Surgical Congress in San Diego. The subject was “Social Media and Innovation in Surgery.” In it, I speculated about the probable demise of the traditional printed medical journal. I cited some experts who have deplored the current method of peer review of papers.
I suggested that because of its immediacy, online peer review would emerge as the standard. While you might not think of the BMJ as social media, it does have an online rapid response system allowing letters to the editor to be published immediately, eliminating the usual delay of several months.
If you look at the rapid responses, you will note that there are two major criticisms of the mammography study. One is that the mammography machines used were possibly not of the highest quality. Others have said that any study that lasts as long as the Canadian study will be subject to criticism about technology or techniques. If that disqualifies this study, then there is no point in ever doing a study with 25 years of follow-up.
The other main issue is about the way patients were randomized. I won’t go into detail about it, but if the randomization was truly flawed, the study may not be valid.
The paper’s senior author has come forward with a long rapid response to every criticism.
All this has happened within one week of the publication of the paper.
I have my opinion about the study. You should read it and the rapid responses and judge for yourself.
In a tweet, @ThomWalsh, a post doctoral fellow in health policy and healthcare delivery science at Dartmouth, said an academic manuscript is like a song and a journal is like an album, “and now you see why the current business model for journals is doomed.”
The future of peer review is now. I don’t know who said this, but I agree, “Today, all media is social media.”
Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 8300 followers on Twitter.