Papas Fritas writes:
"In the United States, about 37 million mammograms are performed annually at a cost of about $100 per mammogram and nearly three-quarters of women age 40 and over say they had a mammogram in the past year. Now the NYT reports that a study involving 90,000 women and lasting a quarter-century has added powerful new doubts about the value of the screening test for women of any age finding that the death rates from breast cancer and from all causes were the same in women who got mammograms and those who did not.
'It will make women uncomfortable, and they should be uncomfortable,' says screening expert Dr. Russell P. Harris who was not involved in the study. 'The decision to have a mammogram should not be a slam dunk.' An editorial accompanying the new study says that earlier studies that found mammograms helped women were done before the routine use of drugs like tamoxifen that sharply reduced the breast cancer death rate. In addition, many previous studies did not use the gold-standard methods of the clinical trial, randomly assigning women to be screened or not, noted the editorial's author, Dr. Mette Kalager. According to Kalager, with better treatments, like tamoxifen, it is less important to find cancers early.
Also, she says, women in the study were aware of breast cancer and its dangers, unlike women in earlier studies who were more likely to ignore lumps. 'As time goes by we do indeed need more efficient mechanisms to reconsider priorities and recommendations for mammography screening and other medical interventions,' concludes Kalager. 'This is not an easy task, because governments, research funders, scientists, and medical practitioners may have vested interests in continuing activities that are well established.'"
Can you comment on the efficacy of x-ray based mammograms versus the "copping a feel" method?
Is the manual method ineffective enough to be considered obsolete in comparison, or is this a case of "we have a shiny expensive toy, we'd better use it"?
As it is not my area, I won't make any comments on efficacy. A few global things though: in general, study/screening protocols contain both a clinical examination and a mammography, that makes a direct comparison of the two difficult (impossible if you are strict).
For more or less all clinical examination goes that there is a quite a lot of inter- and intra-observer variability (i.e. same patient different results of the examination by different doctors and same patient different result in subsequent examinations by the same doctor resp.) and technique matters a lot as well (which also goes for self examination). Finally, clinical examinations are really difficult to properly standardize.
In the end these issues make it extremely difficult to conduct a strict study on the value of clinical/self examination (in breast cancer, but the same is true in general).