BMJ 2000;321:1470 ( 9 December )

Letters

Survival and reduction in mortality from breast cancer

    Impact of mammographic screening is not clear
    Diagnostic practice in the United States is different
    Improvements in survival may be an illusion
    "Avoided deaths" may not be useful for predicting mortality reductions from cancer
    Authors' reply

Impact of mammographic screening is not clear

The first 150 words of the full text of this article appear below.

EDITOR---We should all rejoice that there has been an improvement in survival and reduction in mortality for carcinoma of the breast, but Richards et al in their paper perpetuate the myth that this is related to the breast screening programme.1 The periods for comparison were 1981-5 and 1986-90.

The Forrest report on mammographic screening was published in 1986,2 the first screening centres were established in 1988, and the country was not covered by the programme until 1990. Even the greatest zealots for mammographic screening would not expect an impact on mortality until 1997. The fall in mortality could therefore be attributed only to improvements in treatment, and it is relevant to note that the first overview of the trials of adjuvant systemic treatment were published in 1985.3 The only support for the assertion that the reduction in mortality can be attributed to the breast screening programme was a personal communication from . . . [Full text of this article]
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