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Is 28% Reduced Risk Of Death For Mammography ‘Modest’?

June 25, 2014
Written by: , Filed in: Breast Imaging
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Is a 28 percent reduced risk of death from breast cancer enough?

That was the question debated last week in the virtual pages of BMJ. A Norwegian study published online June 17 looked at all Norwegian women age 50 to 79 years between 1986 and 2009. During that period, Norway gradually introduced mammography screening for breast cancer. The researchers found the following:

Based on more than 15 million person years of observation, we estimated that invitation to mammography screening was associated with a 28% reduced risk of death from breast cancer compared with not being invited to screening, and that 368 women need to be invited to screening to prevent one death from breast cancer.

The researchers also found that the reduced risk of breast cancer death persisted after invitations to screenings ended at age 70 but seemed to gradually decrease over time.

That didn’t impress Joann G. Elmore, MD, professor of medicine at the University of Washington School of Medicine, and Russell P. Harris, MD, professor of medicine at the University of North Carolina. In an editorial also published online June 17 by BMJ, Drs. Elmore and Harris said the Norwegian study confirmed that the benefits of mammography screening are “modest at best.”

They added, “While the benefits are small, the harms of screening are real and include overdiagnosis, psychological stress, and exorbitant healthcare costs.” They recommended that women be given additional “balanced information about the benefits and harms of screening.”

The debate continues—on a thoughtful, respectful level, mostly—in the online responses to both articles. For example, Willemina J. Rietsema, a general practitioner in primary care practice at the University of Oxford in England, commented in a response to the study article that mammography screening carries secondary benefits as well as harms.

“Women value more than just mortality reduction,” Dr. Rietsema wrote. “Early detection of smaller tumours may reduce the need for mastectomy, axillary lymph node dissection, and chemotherapy. Even when these aspects of treatment do not affect mortality statistics, they do affect women’s quality of life and the cost of their care.”

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Early injection of an imaging agent—the day before surgery—helps in detecting cancer that has metastasized to lymph nodes in patients with advanced breast cancer. For details, see our Facebook page.

Related CME seminar (up to 12 AMA PRA Category 1 credits™): National Conference on Cutting Edge Breast Imaging Topics (all new; just released)

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