Intended for healthcare professionals


Benefits and harms of mammography screening

BMJ 2012; 344 doi: (Published 06 January 2012) Cite this as: BMJ 2012;344:d8279
  1. Allan Hackshaw, professor
  1. 1Cancer Research UK and UCL Cancer Trials Centre, Cancer Institute, University College London, London W1T 4TJ, UK
  1. a.hackshaw{at}

Using evidence from randomised and observational studies is necessary and appropriate

Discussions over mammography screening began with the view that it does not reduce deaths from breast cancer. More recently this has changed to the view that it probably does reduce mortality but the size of the effect is unclear.1 This has led to the proposed review of breast cancer screening in the United Kingdom.2 According to Mike Richards, England’s cancer tsar, anyone who has published in this field will be excluded from the panel. However, surely it would be better to include some of the proponents and opponents, who are already aware of key features specific to cancer screening through many years of experience?

Most publications on mammography screening have examined the effects on mortality separately from harms, such as overtreatment and increased anxiety after a false positive result. One of the linked articles attempts to combine benefits and harms (doi:10.1136/bmj.d7627),3 and the other (doi:10.1136/bmj.d7017) provides an estimate of overdiagnosis (the proportion of women diagnosed with breast cancer through screening who would not have been detected in the absence of screening, and they therefore receive treatment unnecessarily). …

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