Mammography screening-the debate continues

N.B. Please note that if you are outside North America the embargo time for Lancet Press Material is 0001 hours UK Time Friday 1st February 2002.

Another twist in the controversial debate surrounding the value of mammography screening for breast cancer is presented in a fast-track research letter and on THE LANCETs website this week.

The publication of a meta-analysis by Danish investigators Olsen and Gotzsche (Lancet 2000; 355: 129-34) and a follow-up analysis (Lancet 2001; 358:1340-42), concluded that there was no evidence that mammography screening saves lives (based on data from the two reliable randomised trials done in Sweden and Canada). Publication of both papers resulted in extensive media coverage, notably in the USA where front-page news, editorial, and correspondence appeared in the New York Times in December 2001. Although there remains considerable public confusion over mammography screening, last week the US-based PDQ Screening and Prevention Editorial Board concluded that there was insufficient evidence to show that mammograms prevented breast-cancer deaths, and said it would rewrite its previous statements to reflect this view.

A new perspective on the mammography debate is detailed by Claudia Henschke and colleagues from CornellMedical Center, New York, USA. They reviewed the Swedish trial previously reviewed by Gotzsche and Olsen, and conclude that reduction in breast-cancer mortality is apparent after sufficient time has elapsed-around seven years-for the influence of successful screening and treatment to take effect. They state that the reduction in breast-cancer mortality is substantial (55%) for women aged 55 years or older at entry to the study who were followed up 8-11 years after screening; the corresponding risk reduction among women aged 45-54 years at study entry was estimated at 30%.

Claudia Henschke comments: "It is critical to understand two deceptively simple but fundamental facts which

Contact: Richard Lane

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