Editorials

Breast cancer screening: what does the future hold?

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f87 (Published 23 January 2013) Cite this as: BMJ 2013;346:f87
  1. Cliona C Kirwan, National Institute for Health Research clinician scientist in surgical oncology
  1. 1Institute of Cancer, University of Manchester, Department of Academic Surgery, Education and Research Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
  1. cliona.kirwan{at}manchester.ac.uk

Overdiagnosis remains a problem; quantifying its effects and minimising its impact are priorities

The role of national breast screening programmes and the quality and transparency of information given to participating women are increasingly the subject of heated debate. In the past 12 months alone, the BMJ, the Lancet, and the New England Journal of Medicine have published 24 articles or communications debating the value of breast cancer screening. After calls for an impartial review of the value of breast screening in the United Kingdom, the findings of an independent panel of experts, led by Professor Marmot, were published in November 2012.1

Currently in the UK, women aged 50-70 years are invited for screening every three years; 2.3 million women were invited during 2010-11. The rate of uptake currently stands at 73.4%, having steadily increased in the past decade.2

The primary aim of screening is to reduce mortality from breast cancer. Reduced breast cancer related mortality is balanced against the cost of screening in terms of physical and psychological harm to women and the financial impact on health services.

Much recent debate has concerned overdiagnosis—that is, diagnosis of a condition that would never cause symptoms or death during a patient’s lifetime. Although over-investigation can cause harm (pain and anxiety from mammography and biopsies), this is usually …

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