Screening for breast cancer

Few topics in medicine have been the subject of so much debate and controversy as breast screening by mammography. The value of screening in reducing mortality has been questioned not only by sceptics1 but also by those involved in setting up and running screening programmes.2 3 The latest addition to the debate is a report published last week by the Advisory Committee on Breast Screening, summarising results from the English breast screening programme.4 Although the authors are respected members of the “breast scientific community,” they cannot be considered to be independent because they are involved in the delivery and organisation of the programme. What does the report tell us about the current status of breast screening?

Many of the early breast screening trials have been criticised because groups, rather than individuals, were randomised. In 2000 Gøtzsche and Olsen excluded trials that randomised groups of women from their analysis and found no reduction in mortality.1 ears later a review of all trials by the International Agency for Research into Cancer concluded that mammographic screening in women aged 50-69 did reduce mortality …