Effect of screening programme on mortality from breast cancer

doi:10.1136/bmj.321.7275.1527/a

BMJ 2000;321:1527 ( 16 December )

Letters

Effect of screening programme on mortality from breast cancer

Benefit of 30% may be substantial overestimate

Women might not accept mammography if benefit is lower than is currently thought

Investment in treatment would be more cost effective

Benefit of 30% may be substantial overestimate

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

EDITOR $---$ Blanks et al have attempted to model the decline in mortality from breast cancer in England and Wales and to estimatethe proportion of this decline due to screening.¹ Unfortunately,even their estimate of a modest effect may be too large: the effectof tamoxifen at ages 55-74 may be larger than that at ages 50-54,as many of these younger women may be premenopausal and have oestrogennegative cancers, gaining less benefit fromtamoxifen.

Blanks et al do not comment on the unexplained rise in mortality from breast cancer in the United Kingdom from about 1965to 1990. The recent fall in this mortality in the United Kingdommay have been partly due to the removal of the factor that causedthe rise. Such a rise was not seen in North America, where mortalityfrom breast cancer was stable until about 1990, since when similarfalls in both Canada and . . . [Full text of this article]

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