Screening Mammography - A Long Run for a Short Slide?

New England Journal of Medicine (Impact Factor: 55.87). 09/2010; 363(13):1276-8. DOI: 10.1056/NEJMe1008369
Source: PubMed
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    • "Although mammography screening is one of the screening programs most carefully studied, it continues to be one of the most debated issues within the medical community [25]. The effectiveness of mammography screening programs in reducing breast cancer mortality was recently questioned [9,10]. "
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    ABSTRACT: The use of screening mammography is still under debate within the medical community. The aim of this study is to define a balance sheet of benefits (breast cancer mortality reduction) and harms (overdiagnosis) for mammography screening programs. We compared breast cancer incidence and mortality in two cohorts of women, defined as 'attenders' or 'non-attenders' on the basis of the individual attitudes towards screening, who were invited to the first round of the Florentine screening program. The effects of screening exposure on breast cancer incidence and mortality were evaluated by fitting Poisson regression models adjusted for age at entry, marital status and deprivation index. We performed a sensitivity analysis excluding 34 women not responding to the invitation with a breast cancer diagnosis in the following six months. In total, we included 51,096 women aged 50 to 69 years invited at the first screening round (1991 to 1993) and followed-up for breast cancer incidence and mortality until 31 December 2007 and 31 December 2008, respectively The estimate of mortality reduction varies from 45% among 50 to 59 year-old women up to 51% among 60 to 69 year-old women. The estimate of overdiagnosis, according to the cumulative-incidence method, is an additional 10% of all breast cancer cases among 60 to 69 year-old women screened. Comparing the breast cancer mortality and breast cancer incidence between attenders and non-attenders, we have determined that the overall cost to save one life corresponds to no more than one over-diagnosed tumor (from 0.6 to 1 depending on the selection criteria of the cohort), even if a residual self-selection bias cannot be excluded.
    Full-text · Article · Jan 2012 · Breast cancer research: BCR
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    • "Moreover, publicity about screening may be partly responsible for raising breast cancer anxiety in the first place, making it questionable whether anxiety reduction can legitimately be considered a benefit of screening (Barratt et al., 1999). The public perception of mammography as undeniably valuable is partly due to the persuasive impact of decades of screening promotion campaigns (Schwartz et al., 2004; Welch, 2010). Written materials produced by mammography programmes around the world frequently overestimate benefits and neglect harms (Gummersbach et al., 2010; Jorgensen and Gotzsche, 2006; Zapka et al., 2006). "
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    ABSTRACT: In current medical literature, mammography and other cancer screening programs are subject to controversy because of debate about the magnitude and nature of the benefits and harms. This paper discusses the issues around informed choice for women considering breast screening. We discuss qualitative and quantitative studies of women's attitudes to breast screening and informed choice. Women view breast screening as a way of avoiding potential regret, and reassurance from normal results is highly valued. Screening participants acknowledge anxiety about false positives but awareness regarding potential overdetection of indolent breast cancer is minimal, and research is needed to assess how better understanding of screening downsides may affect women's views. In any case, weighing up screening advantages and disadvantages is sensitive to personal preferences. Communicators have an ethical obligation to make balanced information available to women, which is flexible enough to respond to the level of detail and involvement desired by each individual. Many women want to know more and to participate more actively in screening decisions. Techniques have been developed to present balanced information and support individual decision making in ways that are accessible and empowering for the wider community. Evaluations of breast cancer screening must integrate clinical data with evidence on the perspectives of women themselves.
    Full-text · Article · Jun 2011 · Preventive Medicine
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