The evidence base for breast cancer screening

Paul Glasziou, Nehmat Houssami

Research output: Contribution to journalArticleResearchpeer-review

62 Citations (Scopus)

Abstract

The history of breast cancer screening is littered with controversy. With 10 trials spanning 4 decades, we have a substantial body of evidence, but with different aims and flaws. Combined analysis of the intention-to-treat results gives an overall relative reduction in breast cancer mortality of 19% (95% CI 12%-26%), which, if adjusted for non-attendance gives an approximate 25% relative reduction for those who attend screening. However, given that 4% of all-cause mortality is due to breast cancer deaths, this translates into a less than 1% reduction in all-cause mortality. An emerging issue in interpretation is the improvements in treatment since these trials recruited women. Modern systemic therapy would have improved survival (models suggest between 12% and 21%) in both screened and non-screened groups, which would result in a lesser difference in. absolute risk reduction from screening but probably a similar, or slightly smaller, relative risk reduction. However benefits and harms, particularly over-diagnosis, need to balanced and differ by age-groups. The informed views of recipients of screening are needed to guide current and future policy on screening.

Original languageEnglish
JournalPreventive Medicine
Volume53
Issue number3
DOIs
Publication statusPublished - 1 Sep 2011

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Early Detection of Cancer
Breast Neoplasms
Mortality
Numbers Needed To Treat
Intention to Treat Analysis
Risk Reduction Behavior
Age Groups
History
Survival
Therapeutics

Cite this

Glasziou, Paul ; Houssami, Nehmat. / The evidence base for breast cancer screening. In: Preventive Medicine. 2011 ; Vol. 53, No. 3.
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The evidence base for breast cancer screening. / Glasziou, Paul; Houssami, Nehmat.

In: Preventive Medicine, Vol. 53, No. 3, 01.09.2011.

Research output: Contribution to journalArticleResearchpeer-review

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