The Lancet - that bastion of medical orthodoxy is calling for a major rethink in breast cancer treatment and an admission from the medical profession of the failure of existing treatments.

It is organizing a conference in Belgium next year ("The Challenge of Breast Cancer") which it hopes will prompt doctors "to pause and ask what we have really achieved for women with breast cancer and where we should be going".

Some doctors may be "startled" to learn that despite "all the media hype, the triumphalism of the profession in published research, and the almost weekly miracle breakthroughs trumpeted by the cancer charities" the number of women dying from breast cancer refuses to go down, says a hard hitting editorial (The Lancet, 6 February 1993).

Progress towards an effective treatment will only be made if doctors acknowledge the failure of current approaches. "To sustain the incentive for progress we must eschew complacency and recognize the dangers of a mindless race down familiar pathways when, in all truth, we lost our way several leagues ago along this very route," it says.

"Let us stop complaining that screening ought to work if only we tried harder and ask why this approach is so disappointing."

The Lancet also attacks the medical profession for its "extraordinary capacity for self delusion" and its "continual bickering and disarray over the value and ethics of primary and secondary prevention of the disease".