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Rapid response to:

Analysis

Cost of extending the NHS breast screening age range in England

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1293 (Published 10 April 2019) Cite this as: BMJ 2019;365:l1293

Rapid Response:

Re: Cost of extending the NHS breast screening age range in England

Alexandra Barratt suggests that a strong trial design could address the question of overdiagnosis. However, cessation of screening will lead to a decrease in the observed cancer incidence as a consequence of reverse lead time, because cancers are detected in advance during screening. An accurate interpretation of lead time is necessary before trying to evaluate overdiagnosis. When this is done, it is found that overdiagnosis is much less of an explanation of the increased incidence of cancer after national screening was implemented than breast cancer caused by the radiation of screening mammography (1). Thus, the group without screening after the age of 70 years will not show a large difference in cancer incidence at the age of 75 years as compared to the screened group, if the incidence increase is primarily due to the carcinogenesis of radiation.  Any study design that studies the effect of screening cessation will also help determine the degree to which screening mammography actually causes breast cancer.

The observed incidence of breast cancer (invasive + in situ) has almost doubled in women aged 65-69 years in the United Kingdom between 1996 and 2006, after the NHS breast cancer screening program was implemented for women aged from 50 to 64 years. Similar stable increases are seen in other countries after waiting enough time after implementation of screening. We are facing an epidemic of mammography-induced cancers.

1) https://www.biorxiv.org/content/10.1101/238527v1

Competing interests: No competing interests

15 May 2019
Daniel Corcos
MD, PhD, Researcher
Paris