Is screening for breast cancer with mammography justifiable?
The LancetPublished 1 January 2000
Peter C Gøtzsche, Ole Olsen
Citations860
SJR quartileQ1
SJR score12.11
SNIP22.72
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TL;DR
Screening for breast cancer with mammography is unjustified because for every 1000 women screened biennially throughout 12 years, one breast-cancer death is avoided whereas the total number of deaths is increased by six.
Abstract
Screening for breast cancer with mammography is unjustified. If the Swedish trials are judged to be unbiased, the data show that for every 1000 women screened biennially throughout 12 years, one breast-cancer death is avoided whereas the total number of deaths is increased by six. If the Swedish trials (apart from the Malmö trial) are judged to be biased, there is no reliable evidence that screening decreases breast-cancer mortality.
Keywords
MedicineBiochemistry, Genetics and Molecular Biology
JAMARandomized Trial of Estrogen Plus Progestin for Secondary Prevention of Coronary Heart Disease in Postmenopausal Women
6,229 Citations1998Stephen B. Hulley
Treatment with oral conjugated equine estrogen plus medroxyprogesterone acetate did not reduce the overall rate of CHD events in postmenopausal women with established coronary disease and the treatment did increase the rate of thromboembolic events and gallbladder disease.
JAMAEmpirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials
5,580 Citations1995Klaus‐Peter Schulz
Empirical evidence is provided that inadequate methodological approaches in controlled trials, particularly those representing poor allocation concealment, are associated with bias.
The LancetDoes quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?
3,591 Citations1998David Moher, Ba’ Pham +6 more
Study of low methodological quality in which the estimate of quality is incorporated into the meta-analyses can alter the interpretation of the benefit of intervention, whether a scale or component approach is used in the assessment of trial quality.
The LancetREDUCTION IN MORTALITY FROM BREAST CANCER AFTER MASS SCREENING WITH MAMMOGRAPHY
1,795 Citations1985Làszló Tabár, Ahmed Z. Gad +10 more
7 years after the start of the study the excess of stage I cancers in the study group largely outweighs the deficit of advanced cancers, and the results to the end of 1984 show a 31% reduction in mortality from breast cancer and a 25% reduced in the rate of stage II or more advanced breast cancers.
Preventive MedicineEstrogen replacement therapy and coronary heart disease: A quantitative assessment of the epidemiologic evidence
1,601 Citations1991Meir J. Stampfer, Graham A. Colditz
The bulk of the evidence strongly supports a protective effect of estrogens that is unlikely to be explained by confounding factors and is consistent with the effect of Estrogen on lipoprotein subfractions.
JAMAEfficacy of Screening Mammography
1,063 Citations1995Karla Kerlikowske, Deborah Grady +3 more
Screening mammography may be effective in reducing breast cancer mortality in women aged 40 to 49 years after 10 to 12 years of follow-up, but the same benefit could probably be achieved by beginning screening at menopause or 50 years of age.
New England Journal of MedicineTen-Year Risk of False Positive Screening Mammograms and Clinical Breast Examinations
1,055 Citations1998Joann G. Elmore, Mary B. Barton +4 more
Over 10 years, one third of women screened had an abnormal test result that required additional evaluation, even though no breast cancer was present, and Physicians should educate women about the risk of a false positive result from a screening test for breast cancer.
The LancetBreast cancer screening with mammography: overview of Swedish randomised trials
978 Citations1993L. Nyström, Stig Wall +10 more
There was a consistent risk reduction associated with screening in all studies, although the point estimate of the relative risk for all ages varied non-significantly between 0.68 and 0.84.
BMJMammographic screening and mortality from breast cancer: the Malmö mammographic screening trial.
926 Citations1988Ingvar Andersson, Knut Aspegren +7 more
The LancetAngiogenesis, assessed by platelet/endothelial cell adhesion molecule antibodies, as indicator of node metastases and survival in breast cancer
807 Citations1992E Horak, Nicola Klenk +7 more
The results suggest that angiogenesis is closely linked to metastasis, that it is acquired at a critical density of vessels, and that this process occurs as tumours enlarge or become more poorly differentiated.
PubMedCanadian National Breast Screening Study: 1. Breast cancer detection and death rates among women aged 40 to 49 years.
754 Citations1992Anthony B. Miller, Cornelia J. Baines +2 more
Screening with yearly mammography and physical examination of the breasts detected considerably more node-negative, small tumours than usual care, but it had no impact on the rate of death from breast cancer up to 7 years' follow-up from entry.
The LancetCochrane review on screening for breast cancer with mammography
714 Citations2001Ole Olsen, Peter C Gøtzsche
A Cochrane review has confirmed and strengthened previous findings that there is no reliable evidence that screening for breast cancer reduces mortality and shows that breast-cancer mortality is a misleading outcome measure.
CancerEvidence on screening for breast cancer from a randomized trial
577 Citations1977Sam Shapiro
Based on current findings in the HIP study, there appears to be strong support for periodic screening at ages 50 years and over with clinical examination and mammography; to justify screening under 50, new information from other studies is required.
CancerEfficacy of breast cancer screening by age. New results swedish two-county trial
560 Citations1995Làszló Tabár, G Fagerberg +5 more
A small effect of breast cancer screening on breast cancer mortality in women aged younger than 50 years compared with older women and various possible reasons have been suggested are suggested.
The Lancet14 years of follow-up from the Edinburgh randomised trial of breast-cancer screening
392 Citations1999FE Alexander, TJ Anderson +7 more
The findings confirm results from randomised trials in Sweden and the USA that screening for breast cancer lowers breast-cancer mortality and suggest benefit from introduction of screening before 50 years of age.
Journal of Epidemiology & Community HealthThe Swedish two county trial of mammographic screening for breast cancer: recent results and calculation of benefit.
362 Citations1989Làszló Tabár, G Fagerberg +2 more
Results show an increasingly significant deficit in deaths from breast cancer among the 77,092 women invited to screening relative to the 56,000 not invited, with no significant difference between the effects of screening in the two counties, and results remain the same when adjusted for age.
JNCI Journal of the National Cancer InstituteAnalysis of Breast Cancer Mortality and Stage Distribution by Age for the Health Insurance Plan Clinical Trial
304 Citations1988K. C. Chu, Charles R. Smart +1 more
The reduced breast cancer mortality in the study group appears to result from lower mortality in stage I cases as well as from earlier case detection, and this may explain differences between the two age-at-entry cohorts in the length of follow-up time required to demonstrate a mortality reduction due to screening.
American Journal of RoentgenologyCanadian National Breast Screening Study.
291 Citations1990A. B. Miller, Cornelia J. Baines +1 more
CPOBGYN. Clinical perspectives in obstetrics and gynecologyEstrogen Replacement Therapy
268 Citations1983Clare D. Edman
Hot flashes, atrophy of the vaginal epithelium, and prevention of osteoporosis have been established as indications for estrogen replacement therapy, and Oral administration of estrogen is the preferred route despite misgivings about portal absorption and liver metabolism.
Breast Cancer Research and TreatmentRandomized study of mammography screening — preliminary report on mortality in the stockholm trial
262 Citations1991Jan Frisell, Gunnar Eklund +4 more
A randomized trial of breast cancer screening by single-view mammography alone versus no intervention in a control group of 20,000 women and the estimate of mortality reduction lies between the results from two earlier Swedish randomized controlled trials.
JNCI MonographsReduced Breast Cancer Mortality in Women Under Age 50: Updated Results From the Malmö Mammographic Screening Program
250 Citations1997Ingvar Andersson, Lars Janzon
This article provides additional follow-up data of two cohorts from the Malmö Mammographic Screening Trial (MMST) by pooling the two cohorts and showed a statistically significant 36% reduction in breast cancer mortality in the intervention groups.
Breast Cancer Research and TreatmentFollowup after 11 years – update of mortality results in the Stockholm mammographic screening trial
224 Citations1997Jan Frisell, Elisabet Lidbrink +2 more
The purpose of this article is to present data on mortality in breast cancer in study and control groups of the Stockholm trial after 11 years of followup, to analyse which age groupbenefits most from screening, and whether mammographic screening can be successful in younger age groups.
PubMedThe Gothenburg breast screening trial: first results on mortality, incidence, and mode of detection for women ages 39-49 years at randomization.
195 Citations1997Nils Bjurstam, Lena Björneld +10 more
BMJChanges in incidence of and mortality from breast cancer in England and Wales since introduction of screening
179 Citations1995Mike Quinn, Elizabeth Allen
Since the introduction of screening there have been pronounced increases in recorded incidence in the screened age group, including a steep decrease in mortality in 55-69 year olds which began three years after screening started.
JNCI Journal of the National Cancer InstituteQuantitative Interpretation of Age-Specific Mortality Reductions From the Swedish Breast Cancer-Screening Trials
175 Citations1995H.J. de Koning, Rob Boer +3 more
Results from the Swedish randomized breast cancer-screening trials should be seen as more favorable regarding the effect of mammographic screening in reducing breast cancer mortality for women aged 50-69 years than was estimated earlier.
BMJEffectiveness of the public health policy for breast cancer screening in Finland: population based cohort study
164 Citations1997Matti Hakama, Eero Pukkala +2 more
RadiologyScreening for breast cancer: the Swedish trial.
148 Citations1981Làszló Tabár, Ahmed Z. Gad
A randomized, controlled mammographic screening procedure has been initiated in Sweden and since 1977 in Kopparberg county and since 1978 in Ostergötland county as well as the method of screening used.
International Journal of CancerThe impact of a breast cancer screening programme on quality‐adjusted life‐years
137 Citations1991J.C.J.M. de Haes, Harry J. de Koning +4 more
It is concluded that the adjustment made in the MISCAN model predicting the prevalence of disease/treatment phases with and without a 2‐yearly screening programme for women aged 50‐70 is too small to attribute a major role to quality of life in the decision to undertake a large‐scale breast cancer screening programme.
International Journal of CancerNation-wide breast cancer screening in The Netherlands: Results of initial and subsequent screening 1990–1995
131 Citations1998Jacques Fracheboud, Harry J. de Koning +7 more
The results of subsequent screens did not fulfil expectations with regard to breast cancer detection and tumour size distribution, and it is concluded that the nation‐wide screening programme is being implemented successfully.
British Journal of CancerThe Edinburgh randomised trial of breast cancer screening: results after 10 years of follow-up
131 Citations1994FE Alexander, TJ Anderson +10 more
Rates of locally advanced and metastatic cancer were substantially lower in the study group, but screening has failed to achieve marked reductions in rates of small node-positive cancers.
American Journal of RoentgenologyCanadian National Breast Screening Study: assessment of technical quality by external review.
125 Citations1990Cornelia J. Baines, Anthony B. Miller +6 more
A retrospective review of NBSS mammography by three external reviewers confirmed that technical quality improved from 1980 to 1987, and was associated with improved technology (film, processing, and units) and with the quality assurance programs operating during the NBSs, which identified problems and offered remedies.
American Journal of Public HealthImpact of efforts to increase participation in repetitive screenings for early breast cancer detection.
120 Citations1972Raymond Fink, S Shapiro +1 more
CancerScreening: Assessment of current studies
116 Citations1994Sam Shapiro
This work concludes that routine mass screening programs with mammography should cover women aged 40–49, and that results of studies on this question are affected by differences in design, adequacy of sample size, quality of mammography, period of follow‐up, and other methodologic and content issues.
Breast Cancer Research and TreatmentRandomized mammographic screening for breast cancer in Stockholm
98 Citations1986Jan Frisell, Ulla Glas +2 more
The present results differ only slightly from other screening programs; the percentages of patients with axillary metastases and stage II tumours are similar in the Stockholm, Malmö and Kopparberg/Östergötland studies.
JNCI MonographsThe Canadian National Breast Screening Study: Update on Breast Cancer Mortality
96 Citations1997Anthony B. Miller, Teresa To +2 more
The Canadian National Breast Screening Study, conducted on women age 40-49, was designed to evaluate the efficacy of combined annual mammography and physical examination of the breasts in reducing breast cancer mortality in comparison to usual care (UC) controls.
British Journal of CancerThe Edinburgh randomised trial of screening for breast cancer: Description of method
92 Citations1984M M Roberts, F E Alexander +8 more
This study was extended to a randomised trial with its own control population within the city of Edinburgh, with a power of 83% of detecting a reduction in mortality of 35% after 7 years of follow-up and aPower of 95% of detects a similar reduction at 10 years (alpha = 0.05, one-sided test).
PubMedEvaluation of periodic breast cancer screening with mammography. Methodology and early observations.
90 Citations1966Sam Shapiro, Philip Strax +1 more
PubMedSignificant reduction in advanced breast cancer. Results of the first seven years of mammography screening in Kopparberg, Sweden.
89 Citations1985Làszló Tabár, Gad A +2 more
A significant change in the stage distribution of breast cancers in the cohort invited to undergo screening (ASP) as compared to the control group is seen and whether these preliminary findings will result in decreased breast cancer mortality in the population invited to screening is investigated.
Journal of Medical ScreeningAn Overview of the Swedish Randomised Mammography Trials: Total Mortality Pattern and the Representivity of the Study Cohorts
89 Citations1996Lennarth Nyström, Lars‐Gunnar Larsson +7 more
The cause of death pattern in the invited group was very similar to that in the control group, showing that the groups were comparable, and the quantitative results from these trials may safely be generalised to the Swedish population.
Annals of Internal MedicineThe Canadian National Breast Screening Study: A Perspective on Criticisms
75 Citations1994Cornelia J. Baines
The results of the Canadian National Breast Screening Study showed no reduction in breast cancer mortality after 7 years in screened women aged 40 to 49 years and some of the criticisms that have been generated are addressed in this article in the hope that a better understanding of the issues involved will be reached.
International Journal of EpidemiologyAn Analysis of the Mortality Effect in a Breast Cancer Screening Study
74 Citations1986Joan L. Aron, P. C. PROROK
It is concluded that some, but not all, of the breast cancer cases detected early as a result of screening realized a benefit in terms of elimination of the risk of breast cancer mortality.
Acta Radiologica OncologyEffects of Repeated Mammographic Screening on Breast Cancer Stage Distribution: Results from a randomised study of 92 934 women in a Swedish county
74 Citations1985G Fagerberg, L. Baldetorp +4 more
The yearly incidence of stage II or more advanced breast cancers after the initial screening round up to and including the second was reduced by 40 per cent in the study group compared with the controls, and this effect was less marked in the age group 40-49.
JAMAEvaluation of Periodic Breast Cancer Screening With Mammography
65 Citations1966Sam Shapiro
Results of the study to date are consistent with the hypothesis that the screening leads to earlier detection of breast cancers than is ordinarily experienced and that mammography contributes significantly to detection.
Journal of Medical ScreeningResults from the NHS Breast Screening Programme 1990–1993
63 Citations1995Sue Moss, Marc Michel +4 more
While the majority of interim targets are being met by the NHSBSP, the rate of detection of small invasive cancers requires careful monitoring and collection of more accurate data on size of cancers and interval cancer rates will give a better indication of progress towards the target mortality reduction.
PubMedRandomization in the Canadian National Breast Screening Study: a review for evidence of subversion.
62 Citations1997John C. Bailar, Brian MacMahon
The authors' thorough review of ways in which the randomization could have been subverted failed to uncover credible evidence of it and it is concluded that even if there had been acts of subversion, they could only have been few in number and, given that there was only 1 death from breast cancer in the group reviewed, the alterations could have had only a trivial effect on the study findings.
Journal of Medical ScreeningReduction in breast cancer mortality due to the introduction of mass screening in the Netherlands: comparison with the United Kingdom
60 Citations1999M. Elske van den Akker‐van Marle, Harry J. de Koning +2 more
The effects of screening will be small in the first years after the start of the programme, and the mortality reduction due to screening in the age group 55–74 is expected to increase gradually to 18% in 1999, 10 Years after the introduction of screening, and to 29% in the long term.
Journal of Epidemiology & Community HealthRandomisation by cluster and the problem of social class bias.
46 Citations1989FE Alexander, M M Roberts +2 more
It is found that spurious mortality differences were present in the analyses, which do not allow for socio-economic status, and it is recommended that for future studies with outcome related to socio-Economic status, randomisations which use this design be stratified by socio- economic criteria where this is feasible.
The LancetOn being the right size: a reappraisal of mammography trials in Canada and Sweden
44 Citations1997Steven A. Narod
I feel I have got to know Schopenhauer over the years and I am sure he would welcome the attention he is receiving, so I stand by my translation which, in fact, neatly fits both versions.
PubMed[Mammographic screening does not reduce breast cancer mortality].
31 Citations1999Göran Sjönell, Elisabeth Ståhle
The outcome of a Swedish mammographic screening programme has been studied by analysis of official health statistics for 1987-96 and found that the observed number of deaths was 55 (0.8%) less than would have been expected had the screening not been performed.