Letters Breast screening and mortality

Beware using secular trends in deaths to judge effectiveness of breast screening

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4335 (Published 10 July 2013) Cite this as: BMJ 2013;347:f4335
  1. David H Brewster, director, Scottish Cancer Registry and honorary clinical senior lecturer, University of Edinburgh1,
  2. Lesley A Bhatti, senior statistician1,
  3. Catherine S Thomson, head of statistical information2,
  4. David A Cameron, professor of oncology, University of Edinburgh and director of cancer services, NHS Lothian3,
  5. John A Dewar, professor of clinical oncology (retired)4
  1. 1Information Services Division, NHS National Services Scotland, Edinburgh EH12 9EB, UK
  2. 2Cancer Research UK, London EC1V 4AD, UK
  3. 3Edinburgh Cancer Research UK Centre, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XR, UK
  4. 4Department of Surgery and Molecular Oncology, Medical School, Ninewells Hospital, Dundee DD1 9SY, UK
  1. David.Brewster{at}nhs.net

At least three papers have now used comparisons of secular trends in age specific mortality in breast cancer to make inferences about the effectiveness of mammographic screening.1 2 3 4 However, Autier et al were circumspect in their interpretation, acknowledging that the “larger reduction in mortality in women <50 years old may reflect better targeting of effective treatments and response to …

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