The latest paper by Moshina et al Automated Volumetric Analysis.. in Radiology. 2018 Jun 26 confirms what we all know. Sensitivity is reduced in women with dense breasts, but be careful quoting since screening was every two years.

June 24, 2018@VinayPrasadMD began “Tweetorial2" on mammography screening reviewing a paper that he misunderstood promulgating misinformation. Ignoring science, and academic discourse, Dr. Prasad has blocked me so Iwill tweet out responses and hope that they get disseminated

The paper by Drs. Bleyer (why a pediatric oncologist would write on breast cancer screening) and Welch (a PCP who does not provide care for women with breast cancer) (B&W) in the New England Journal of Medicine. Dr. Prasad is clearly in awe of the NEJM ignoring major errors.

Peer review at the NEJM failed. B&W claimed mammography was responsible for massive overdiagnosis of breast cancer! How can you fault mammography when the authors had no data on who had mammograms and which cancers were found by mammography? Basic 1st year medical school stuff!

More than 40 experts in breast cancer (radiologists, surgeons, and oncologists) wrote a Letter to the Editor of the NEJM urging that, because the paper by B&W lacked scientific validity, it should be withdrawn. The NEJM refused to publish the letter. So much for ethics.

Dr.Prasad attacks “proponents” as being too angry to read "classic papers. In fact, screening experts do not simply accept something because it is published. We read everything carefully and challenge faulty analyses. Prasad promulgates scientifically unsupportable material.

B&W and Prasad are wrong. They ignored the steady increase in invasive cancers back to 1940. Likely continuing, the annual average % increase (APC) of 1-1.3% means that there has been no excess of invasive cancers and the rate of advanced cancers has declined dramatically.

Dr. Prasad did not look carefully at the data for women YOUNGER than 40. He was misled by the short scale missing the 1% APC of early and advanced cancers. Had B&W used this same baseline increase, they would have found no excess cancers and a major decline in advanced cancers!

Prasad accepted the nonsense claim that the breast cancers in 70,000 women in 2008 alone would have disappeared had they not been found by mammography yet no one has ever seen a mammographically detected breast cancer disappear! 70,000 in one year yet not a single case??!!!

Mammographically detected breast cancers do not disappear on their own!! Arleo et al. Persistent untreated screening-detected breast cancer: J Am Coll Radiol 2017; 14:863-867- Almost 500 untreated mammographically detected cancers. None had regressed or disappeared at follow-up.

Dr. Prasad is clearly awed by the NEJM despite its long history of bias against breast cancer screening refusing to publish papers supporting screening particularly for women ages 40-49 while publishing numerous, scientifically unsupportable, anti-screening papers like B&W's.

Dr. Prasad I would expect that a knowledgeable expert like yourself would not be afraid of a dumb radiologist and would unblock your Twitter feed. I am happy to have a direct discussion.

As far as Dr. Prasad's false claim that therapy is the reason for the major decline in deaths in the U.S. Therapy cannot cure advanced breast cancers. Treating breast cancers earlier is what saves lives.

40,000 women still die each year from breast cancer despite improvements in therapy. Our Harvard study (Webb,et al. A failure analysis of invasive breast cancer: Cancer. 2014 ) showed that 71% women who died from breast cancer were among the 20% not participating in screening.

You need to become informed. Randomized, controlled trials PROVED screening saves lives for ages 40-74 - confirmed by numerous observational studies; failure analysis; incidence of death studies. There are NO data to support the age of 50 as a threshold for screening.

CR falsely claims consensus 4 waiting until 45 or 50 and biennial screening. False! Consensus = Annual starting at 40 saves the most lives.

Ignored "harm" - If you tell women to wait until 45 or 50 to start biennial screening explain that tens of thousands will die unnecessarily.

USPST forgot to tell women a harm of waiting until 50 and screening biennially is 100,000 unnecessary deaths for women now in their 30's.

Hendrick et al USPSTF Guidelines on Screening Mammography Recommendations: Science Ignored. Am. J. Roentgenology 2011; 196: Update in press.

"In press" means it has been accepted and is in the process of being published. The update confirms the 2011 analysis.