LETTER
The Breast Cancer Screening Controversy Continues
Charles J. Wright
1 May 1993 | Volume 118 Issue 9 | Pages 746-749
TO THE EDITOR:
Your editorial [1] makes a very appropriate recommendation on the need to review the current recommendations on mammographic screening for breast cancer in younger women. However, you continue to support mammographic screening in women over 50 years old, stating that "at least five major randomized, controlled trials, three case–control studies, and one cohort study have been conducted, all finding that screening for breast cancer saves lives in women ages 50 to 74." Of the five major randomized, controlled trials reported in the literature, only the first two—the HIP study and the Swedish National Board of Health study—claimed a significant difference. The Malmo study [2], the Edinburgh study [3], and the recently published Canadian study [4] showed no significant difference in any age group. It is interesting to observe the
progressively lower claimed benefit in the chronological sequence of reported randomized trials with the progressive increase in the quality of mammography and the rigor of the trial design and analysis. The editorial supported uncritically the oft repeated claim of benefit that reflects more hope than reality.
It was correctly stated that the major dispute in breast cancer screening today concerns offering routine mammography to women in their 40s, but the evidence clearly suggests that the dispute should concern the issue of routine mammography at any age.
1. Fletcher SW, Fletcher RH. The breast is close to the heart. Ann Intern Med. 1992; 117:969-71.
2. Andersson I, Aspegren K, Janzon L, Landberg T, Lindholm K, Linell F, et al. Mammographic screening and mortality from breast cancer: the Malmo mammographic screening trial. Br Med J. 1988; 297:943-8.
3. Roberts MM, Alexander FE, Anderson TJ, Chetty U, Donnan PT, Forrest P, et al. Edinburgh trial of screening for breast cancer: mortality at seven years. Lancet. 1990; 335:241-6.
4. Miller AB, Baines CJ, To T, Wall C. Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 to 59 years. Can Med Assoc J. 1992; 147:1477-88.
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