title: The impact of advances in treatment on the efficacy of mammography screening.
abstract: OBJECTIVE
  The objective of this commentary is to argue that advances in therapy are diminishing the efficacy of mammography screening.
  
  
  METHODS
  Key studies which demonstrate this effect are briefly reviewed.
  
  
  RESULTS
  The author argues that, for screening to be beneficial, the treatment of screen-detected cancers must be more effective than that of clinically-detected cancers. If there was no effective therapy for breast cancer, then screening would offer no benefit. Furthermore, as breast cancer treatments improve over time, both the absolute and relative benefits of screening will diminish. This is evident in the overview of the nine successive mammography screening trials, which have shown a decrease in the benefit of mammography screening over time, with the three most recent trials showing no benefit at all. Breast cancer adjuvant therapy was widely available in the three most recent mammography screening trials, but not the earlier trials. Additionally, population-based studies seem to suggest that the benefit of mammography screening is diminishing as treatments continue to improve.
  
  
  CONCLUSIONS
  Thus, in the years ahead, further declines in breast cancer mortality will likely be fueled by advances in therapy, and not by improvements in screening technology.
authors: Division of Surgical Oncology, University of Texas Health Science Center, 7703 Floyd Curl Drive, Mail Code 7738, San Antonio, Texas 78229-3900, USA. Jatoi@uthscsa.edu
authors: Ismail
authors: I
authors: Jatoi
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D009026:Mortality; D017060:Patient Satisfaction; D040242:Risk Reduction Behavior; D016896:Treatment Outcome; D014481:United States; D016387:Women's Health / Q000706:statistics & numerical data*