Re: Cost of extending the NHS breast screening age range in England
The AgeX trial protocol (http://www.agex.uk/) says it will “assess reliably the risks and benefits of extra screening” before 50 and after 70 years of age. Note wording…risks first, benefits second.
So it is disappointing that the AgeX protocol does not address overdiagnosis. A strong trial design, which attended equivalently to the risks, as well as the benefits, of screening, could include incidence as a primary (not subsidiary) analysis. By continuing to capture breast cancer incidence for five to ten years past the cessation of screening (whether at 70 or 76/79 years), it could provide a robust measure of overdiagnosis. The independent panel review regretted that only 3 of the original mammography screening trials had a design that allowed an unbiased assessment of overdiagnosis. It would be disheartening indeed if a contemporary trial should miss such a valuable opportunity.
Competing interests:
I am co-chair of the International Preventing Overdiagosis Conference, and a lead researcher at Wiser Healthcare, a research collaboration to reduce overdiagnosis and overtreatment.
Rapid Response:
Re: Cost of extending the NHS breast screening age range in England
The AgeX trial protocol (http://www.agex.uk/) says it will “assess reliably the risks and benefits of extra screening” before 50 and after 70 years of age. Note wording…risks first, benefits second.
Overdiagnosis is widely described as a major risk of breast cancer screening, including by Cancer Research UK, the 2012 Independent Panel review of the UK breast screening programme (https://www.cancerresearchuk.org/about-cancer/breast-cancer/screening/sc...) and the American Cancer Society.
So it is disappointing that the AgeX protocol does not address overdiagnosis. A strong trial design, which attended equivalently to the risks, as well as the benefits, of screening, could include incidence as a primary (not subsidiary) analysis. By continuing to capture breast cancer incidence for five to ten years past the cessation of screening (whether at 70 or 76/79 years), it could provide a robust measure of overdiagnosis. The independent panel review regretted that only 3 of the original mammography screening trials had a design that allowed an unbiased assessment of overdiagnosis. It would be disheartening indeed if a contemporary trial should miss such a valuable opportunity.
Competing interests: I am co-chair of the International Preventing Overdiagosis Conference, and a lead researcher at Wiser Healthcare, a research collaboration to reduce overdiagnosis and overtreatment.