Breast cancer screening: controversy of impact.
Few medical issues have been as controversial--or as political, at least in the United States-as the role of mammographic screening for breast cancer. The advantages of finding a cancer early seem obvious. Indeed, randomized trials evaluating screening mammography demonstrate a reduction in breast cancer mortality, but the benefits are less than one would hope. Moreover, the randomized trials are themselves subject to criticism, including that they are irrelevant in the modern era because most were conducted before chemotherapy and hormonal therapy became widely used. In this article I chronicle the evidence and controversies regarding mammographic screening, including attempts to assess the relative contributions of screening and therapy in the substantial decreases in breast cancer mortality that have been observed in many countries over the last 20-25 years. I emphasize the trade-off between harms and benefits depending on the woman's age and other risk factors. I also discuss ways for communicating the associated risks to women who have to decide whether screening (and what screening strategy) is right for them.
Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street, 4-5062 Pickens Academic Tower, Houston, TX 77030-1402, USA. Electronic address: dberry@mdanderson.org.
Donald A
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Berry
D000328:Adult; D000367:Age Factors; D000368:Aged; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005544:Forecasting; D006801:Humans; D008327:Mammography / Q000379:methods* / Q000706:statistics & numerical data; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D010349:Patient Compliance; D061214:Patient Safety; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis
Biases in screening studies; Breast cancer detection; Modeling population breast cancer mortality; Randomized screening trials; Screening mammography