After some decades of contention, one can almost despair and conclude that (paraphrasing) "the mammography debate you will have with you always." Against that sentiment, in this review I argue, after reflecting on some of the major themes of this long-standing debate, that we must begin to move beyond the narrow borders of claim and counterclaim to seek consensus on what the balance of methodologically sound and critically appraised evidence demonstrates, and also to find overlooked underlying convergences; after acknowledging the reality of some residual and non-trivial harms from mammography, to promote effective strategies for harm mitigation; and to encourage deployment of new screening modalities that will render many of the issues and concerns in the debate obsolete.To these ends, I provide a sketch of what this looking forward and beyond the current debate might look like, leveraging advantages from abbreviated breast magnetic resonance imaging technologies (such as the ultrafast and twist protocols) and from digital breast tomosynthesis-also known as three-dimensional mammography. I also locate the debate within the broader context of mammography in the real world as it plays out not for the disputants, but for the stakeholders themselves: the screening-eligible patients and the physicians in the front lines who are charged with enabling both the acts of screening and the facts of screening at their maximally objective and patientaccessible levels to facilitate informed decisions. Key Words REFLECTIONS ON SOME CENTRAL THEMESAll screening programmes do harm; some do good as well, and, of these, some do more good than harm at reasonable cost.-Sir Muir Grey, former director of the U.K. National Screening Committee 1 Some Issues Deserving More AttentionSeveral core issues require closer examination:1. The potential benefits of mammographic screening independent of whether ultimate survival is affected, including diagnosis at earlier stages, typically with smaller tumours and node negativity; reduced likelihood of aggressive treatments and morbidities; detection of high-risk lesions (most diagnosed in the screened group 2 ) allowing for chemoprevention or magnetic resonance imaging (mri) surveillance against occult malignancies, or both; and avoidance of compromised quality of life after diagnosis of advanced disease It is not clear, as often assumed, that survival is the best (or only) measure for judging mammographic screening 2,3 . And it remains open whether claimed harms truly are disproportionate to benefits when using, for instance, a more nuanced definition of overdetection than simply breast cancer (bca) diagnosed but not bca expired (distinguishing, for example, longer recurrence-free survival from simple overall survival benefit).

aThe No Surrender Breast Cancer Foundation is a U.S.-based 501(c)3 not-for-profit organization providing high-quality critically reviewed and appraised information and guidance to the breast cancer community.

No abstract

I thank Dr. Martin Yaffe for his many constructive comments in his thoughtful review of my previous invited editorial, providing valuable insights into the complex and controversial issues of the current mammography debate. [...]

Regrettably, some aspects of the breast cancer screening debate display their own uniquely obfuscating argumentation, more smoke and mirrors than scientific clarity. [...]

-

No abstract

No abstract