“ALTERNATIVE FACTS” AND BREAST CANCER SCREENING
“Alternative Facts” (AF) recently appeared as an outrageous concept in the “political arena”. What most do not realize is that “alternative” facts have been promulgated for decades by those seeking to reduce access to breast cancer screening. This has led to the pseudo “debate” about screening that has persisted for decades due to the “alternative facts” that have been manufactured to keep the “debate” going. Each time an “alternative fact” has been generated to cast doubt on screening, it has been refuted by science ([i]). Unfortunately, as each (true) fact has been established, new “alternative facts” have been manufactured. The article in the Annals of Internal Medicine cited by Nicholas Bakalar in the New York Times is an example of misinformation that got past poor peer review at a major journal and was published despite its lack of scientific rigor. The study from Norway ([ii]), cited by Mr. Bakalar ([iii]), claiming massive “overdiagnosis” due to mammography had no data on who actually had mammograms and no data on which cancers were detected by mammography. How can a test (mammography) be faulted when the “investigators” had no information on who actually had the test? In an earlier, scientifically more rigorous study from Denmark, Njor, et al looked at actual individual patient data and they found that there was little if any “overdiagnosis” due to screening ([iv]) and, another study found, contrary to the conclusions of the paper reviewed by Bakalar, that screening had in fact resulted in a marked decline in deaths from breast cancer in Denmark ([v]).