Minerva

Minerva

BMJ 1996; 312 doi: http://dx.doi.org/10.1136/bmj.312.7036.986 (Published 13 April 1996) Cite this as: BMJ 1996;312:986
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    Each year 500000 women die of complications of pregnancy and childbirth, and 99% of these deaths occur in developing countries. More than one third of the fatalities are due to sepsis and abortion (Health Policy and Planning 1996;11:1-15). The most important action to reduce maternal deaths, says the report, would be to make abortion legal and freely available to all women. Deaths from haemorrhage could be substantially reduced by improving the nutritional status of women of childbearing age.

    The American Cancer Society continues to recommend that mammography should be offered to women from the age of 40, despite lack of clear evidence that starting screening at this age reduces mortality. A report in the “American Journal of Surgery” (1996;171:356-9) gives some data said to support screening from the age of 40: in a consecutive series of needle biopsies after mammography there were 32 cancers in 219 women aged 40-49 and 184 cancers in 542 women aged 50 or over. Screening younger women picks up some cancers, but the rate is far lower than in those past the age of 50.

    Arguing whether or not women under 50 should have mammography is to oversimplify the issue, according to a recent viewpoint article from Canada (Lancet 1996;347:881-2). The combined effects of the increase in incidence with age, changes in biology, and changes …

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