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BMJ 2010; 341 doi: (Published 29 September 2010) Cite this as: BMJ 2010;341:c5275

Breast cancer screening saves lives, but not many

Screening mammography was responsible for about a third of the drop in breast cancer mortality that took place in Norway between 1986 and 2005, say researchers. Even the most optimistic estimates from their nationwide study suggest that mammography for women aged 50-69 reduced deaths from breast cancer by just 10% (or by 2.4 deaths/100 000 person years). This was less than expected, and much less than the impact on deaths reported in early trials.

The study, which compared death rates over time in both screened and unscreened populations, was designed to isolate the effects of screening from other factors that have also improved survival, such as heightened awareness and better treatment. The results are believable, says one commentator, and they probably reflect the current benefits of screening middle aged women in a modern health system (p 1276).

For women in the US, these figures mean that mammography prevents one death from breast cancer for every 2500 women screened, he writes. It’s also responsible for up to 1000 false alarms among the remaining 2499, half of whom will have an unnecessary biopsy. With these estimates, the decision to opt in or opt out is, he says, “a close call” for women. The world has moved on and mass screening for breast cancer may not be the effective strategy it once was.

Subclinical hypothyroidism linked to coronary heart disease, again

Further evidence of a link between subclinical hypothyroidism and coronary heart disease has emerged from a meta-analysis of 55 287 adults in 11 prospective cohorts from the US, Europe, Japan, Brazil, and Australia. Risk of coronary heart disease (CHD) (including death) rose with serum concentrations of thyroid stimulating hormone (TSH), and became significant once concentrations reached 10 mIU/l (hazard ratio for coronary heart disease events 1.89, 95% CI 1.28 to 2.80, relative to euthyroid people). The authors defined subclinical hypothyroidism …

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