The European Journal of Cancer (EJC) acted inappropriately in withdrawing a paper that questioned the benefits of mammography, the authors of the study are charging.
Peter Gtzsche's group from the Nordic Cochrane Center in Denmark published a study in the journal in March criticizing a report on a mammography screening program in Sweden that claimed a large drop in breast cancer mortality. Gtzsche and his colleagues wrote that the data were "flawed and incomplete" and that the incidence of breast cancer and the number of deaths were underreported.
According to Gtzsche, just three weeks after his article was published on the journal's Web site, it was removed. "I was very surprised that the paper was not only withdrawn, but completely removed...There was no trace of it," he told The Scientist.
Gtzsche laid out his concerns regarding the journal's withdrawal procedure in the November 25 issue of The Lancet. He and his colleagues claimed the EJC's editor-in-chief, John Smyth, removed the article because of complaints he received regarding the article's contents, but that the authors were not given the opportunity to respond to these complaints.
The authors also charged that no notice of the article's retraction was published, and that the journal did not follow guidelines for retraction set by the International Committee of Medical Journal Editors.
Gtzsche believes Smyth pulled the article because of pressure from mammography proponents, in particular Peter Dean, a professor of diagnostic radiology at the University of Turku in Finland.
Shortly after Gtzsche's study was published online, Dean -- who was not involved in the Swedish mammography trials -- wrote letters to Smyth and Reed Elsevier, which owns the EJC, stating that Gtzsche's article was based on "shoddy scholarship and serious errors in reading data in the literature" and that the paper unfairly suggests the researchers in the mammography trial skewed their results to show a benefit from the screening. "You have allowed your journal to become a platform for calumny and slander," Dean wrote to Smyth.
"I get rather upset when people tell lies," Dean told The Scientist, "especially when it's a matter of life and death for women." Dean said he worked in the hospital where the trial data were collected, and that the information was carefully and consistently recorded. Gtzsche, he believes, is being led by his own agenda against mammography screening.
The feud between Dean and Gtzsche is not new: In 2004 Dean published an opinion in the Journal of the American College of Radiology tearing down Gtzsche's work. "Gtzsche has built his own anti-screening bias into a nonscientific, personal campaign to discredit breast cancer screening, breast cancer surgery, and breast cancer oncology," he wrote.
Others have also criticized Gtzsche's work. In 2000, Gtzsche and a colleague published a review of Swedish mammography trials in The Lancet that found "no reliable evidence that screening decreases breast-cancer mortality." David Freedman at the University of California, Berkeley and his colleagues analyzed Gtzsche's work several years later and found the critique "careless at best."
Whether Dean's letter to the EJC influenced the journal's decision to retract the paper is not clear. Smyth declined to be interviewed for this article. His assistant told The Scientist in an email that the matter may be subject to legal advice, though Gtzsche said he has not initiated a lawsuit. Jack Cuzick, an associate editor at the journal, also declined an interview, but confirmed that he received correspondence from Dean. No one from Reed Elsevier was available for comment.
After the EJC's retraction, the Danish Medical Bulletin published Gtzsche's article without further peer review. The publication's editor-in-chief, Torben Schroeder, included a note at the end of the article stating that he shared the authors' concerns about the manner in which the paper was withdrawn from the EJC. Schroeder told The Scientist that from an editor's point of view, "it's very worrisome that a paper is plainly removed from a Web site without further assessment, because it was peer-reviewed and accepted."
Gtzsche stands by his analysis of the Swedish screening trials. "We believe our methods are adequate, we believe there were problems with this trial, and we believe this needs to be discussed in the open," he said. "It's terrible to suppress scientific findings."
By Kerry Grens
kgrens@the-scientist.com
Links within this article:
European Journal of Cancer
http://www.journals.elsevierhealth.com/periodicals/EJC/home
PH Zahl et al., WITHDRAWN "Results of the Two-County trials of mammography screening are not compatible with contemporaneous official Swedish breast cancer statistics,"Eur J Cancer, March 9, 2006 (epub ahead of print).
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16530407&query_hl=1&itool=pubmed_docsum
L Tab￡r et al., "Reduction in mortality from breast-cancer after mass-screening with mammography," The Lancet, 8433:829-832, 1985.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=2858707&query_hl=1&itool=pubmed_DocSum
Peter Gtzsche
http://www.cochrane.dk
C. Hinestrosa, "It's Time to Improve Methods for Breast-Cancer Detection," The Scientist, April 30, 2001
http://www.the-scientist.com/article/display/12382/
PC Gtzsche et al., "What is publication?"The Lancet 368:1854-1856. http://www.thelancet.com/journals/lancet/section?volume=368&issue=9550ﾧion=Comment
International Committee of Medical Journal Editors
http://www.icmje.org/index.html
L. Newman, "Developing the Ideal Breast Cancer Screening Test, The Scientist, July 9, 2001
http://www.the-scientist.com/article/display/12492
Peter Dean
http://vanha.med.utu.fi/radiology/index.html
PB Dean, "Gtzsche's quixotic anti-screening campaign: non-scientific and contrary to Cochrane principals," Journal of the American College of Radiology, 1:3-7, 2004.
'http://www.jacr.org/article/PIIS1546144003000164/fulltext
PC Gtzsche and O Olsen, "Is screening for breast cancer with mammography justifiable?" The Lancet 355:129-134, 2000.
http://www.thelancet.com/journals/lancet/full?volume=355&issue=9198
DA Freedman et al., "On the efficacy of screening for breast cancer," International Journal of Epidemiology 33:43-55, 2004.
http://ije.oxfordjournals.org/cgi/content/abstract/33/1/43?ijkey=f3198300a5477290e05a91c48653d4f65c7ffccb&keytype2=tf_ipsecsha
PH Zahl et al., "Results of the Two-County trial of mammography screening are not compatible with contemporaneous official Swedish breast cancer statistics," Danish Medical Bulletin, 53:438-440, 2006.
http://www.danmedbul.dk/Dmb_2006/0406/0406-artikler/DMB3890.htm
A. McCook, "Is Peer Review Broken?" The Scientist, Feb. 1, 2006
http://www.the-scientist.com/article/display/23061
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[Comment posted 2007-01-22 13:17:34]
This is not correct and we have already explained in The Lancet what the problems were (1). Most importantly:
1. Although The European Journal of Cancer is a member of the International Committee of Medical Journal Editors, John Smyth, by his actions, violated seriously the guidelines published by this Committee.
2. Although Elsevier is a member of the International Association of Scientific, Technical & Medical Publishers, John Smyth, by his actions, violated seriously the guidelines published by this Association.
3. Although the peer reviews we have seen were mutually inconsistent we were only given selected ￂﾑComments from the peer review processￂﾒ by John Smyth, and not the full peer reviews. Despite our two appeals, we were not allowed to see the full peer reviews or to comment on those we had seen. This is unprofessional conduct for a journal editor.
Finally, John Smyth did not respond to our paper in The Lancet. It is unprofessional for an editor to decline to defend his actions publicly, in particular when they violate so clearly established international guidelines for editors. This raises a suspicion that the results of our work were so unwelcome that our article was censored, perhaps because of threats of litigation by people with a vested interest in mammography screening. John Smyth should tell us whether this was the case.
1. Gￃﾸtzsche PC, Mￃﾦhlen J, Zahl P-H. What is publication? Lancet 2006;368:1854-5.
[Comment posted 2007-01-12 21:21:12]
After the article by Gotzsche first appeared online as an Article-in-Press for the European Journal of Cancer, it became apparent that the paper in question ("Results of the Two-County trial of mammography screening are not compatible with contemporaneous official Swedish breast cancer statistics") by Zahl, Gotzsche and colleagues contained a comment that might be interpreted as potentially libellous and the paper was therefore removed. Please note that "Articles-in-Press" are peer-reviewed papers which are made available online (through ScienceDirect) but which have not yet been published in the printed journal.
In addition, the EJC Editors then received correspondence criticizing various scientific aspects of the paper. After the removal of their paper from the Article-in-Press stage, Zahl, Gotzsche and colleagues were given the opportunity to submit a revised article which was then submitted to a further round of peer review. The peer reviewers did not recommend acceptance and the EJC Editors rejected this paper. The EJC Editors acted professionally at all times and handled the manuscript fairly and in accordance with the standard editorial policies of the journal.
Elsevier and the EJC take our obligation to publish objectively very seriously , and Elsevier has recently taken steps to promulgate appropriate codes of conduct and best practices with respect to ethics in science publishing (please see Elsevier's Guide to Ethical Publishing on LINK <LINK ). We hope that this clarifies our actions in retracting the article.
Best regards, John Smyth (on behalf of the EJC Editorial team)
[Comment posted 2006-12-23 13:01:01]
Dean continues his unfounded allegations in the interview with The Scientist. Unfortunately, Kerry Grens, the journalist who wrote the piece in The Scientist, failed to describe why it cannot be correct when Dean says in the interview that ￂﾓthe information [in the Two-County study] was carefully and consistently recordedￂﾔ.
We wrote in our research paper in Danish Medical Bulletin:
ￂﾓA recent updated overview of the Swedish randomised screening trials by Nystrￃﾶm and colleagues [7] was based on official mortality statistics. Nystrￃﾶm and colleagues reported only 10% reduction in breast cancer mortality for the ￃﾖstergￃﾶtland part of the Two-County trial (data were not made available for Kopparberg). In contrast, an update of the Two-County trial from Tabar and colleagues [8] reported a 24% mortality reduction. Compared to the update by Nystrￃﾶm and colleagues, Tabar and colleagues reported 10 fewer deaths from breast cancer in the study group despite the fact that the follow-up was slightly longer and the age group was identical, and 23 more in the control group in ￃﾖstergￃﾶtland (Table 1). Such a substantial change is very unlikely to have happened by chance (p< 0.001). According to an investigator involved with the Two-County trial [9], other Swedish trialists [7], and an IARC/WHO report [10], cause-of-death assessments were not blind. This might be the reason why the cause of death determination by a local endpoint committee [11, 12] in Tabar and colleaguesￂﾒ update [8] appears to be seriously flawed.ￂﾔ
On 14 December, I notified Kerry Grens, that I had refuted Deanￂﾒs allegations, but unfortunately, Kerry Grens made no reference to my refutations, but only to the arguments by Dean and Freedman and colleagues. I wrote to Kerry Grens:
ￂﾓIn his letter to the European Journal of Cancer, Dean claims that we should have repeated similar accusations on numerous occasions, despite having them refuted in ￂﾓCorrespondence sections of several journals and publicly in symposia (as I have witnessed in person) as misunderstanding of epidemiological terminology and data, or actual misquoting of the literatureￂﾔ. Dean gives four references to support his views (1-4). The first is to a paper published by the president of the American Cancer Society, Robert A Smith, in a year book quarterly that is not indexed by PubMed. It contains a number of factual errors but we were not invited to comment (1). The three other papers also contained several important errors and misleading quotations, but despite the fact that all the substantial criticisms against our systematic review of mammography screening were refuted in the same journal (5,6), Dean fails to quote these replies and to note that the criticism he raised at a symposium (7) was also refuted (8).ￂﾔ
1 Smith RA. Ideology masquerading as evidence-based medicine: The Cochrane review on screening for breast cancer with mammography. Breast Dis Q 2003;13(4):298-307.
2 Freedman DA, Petitti DM, Robins JM. On the efficacy of screening for breast cancer. Int J Epidemiol 2004;33:4355.
3 Freedman DA, Petitti DM, Robins JM. Rejoinder. Int J Epidemiol 2004;33:6973.
4 Freedman DA, Petitti DM, Robins JM. Authors response. Int J Epidemiol 2004;33:1405-1406.
5 Gￃﾸtzsche PC. On the benefits and harms of screening for breast cancer. Int J Epidemiol 2004;33:56-64.
6 Gￃﾸtzsche PC. Misleading quotations and other errors persist in rejoinder on breast cancer screening. Int J Epidemiol 2004;33:1404.
7 Dean P. Gￃﾸtzsches Quixotic antiscreening campaign: nonscientific and contrary to Cochrane principles. J Am Coll Radiol 2004;1:3-7.
8 Gￃﾸtzsche PC. The debate on breast cancer screening with mammography is important. J Am Coll Radiol 2004;1:8-14.
Finally, I would like to point out that our valid and important criticisms of the Two-Country trial have been published in our updated Cochrane Review of the mammography screening trials which was updated in October 2006 after extensive peer review:
Gￃﾸtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD001877.
I will make this review available shortly on our website: www.cochrane.dk.