- Paper Report
- Open Access
Mammographic screening does not result in a reduction in breast cancer mortality when added to annual clinical breast examinations
- David Cameron1
© Current Science Ltd 2000
- Published: 1 December 2000
- Breast screening
- randomised trial
Regular physical examination has traditionally been thought to have little role in breast cancer screening, with most of the positive randomised trials using mammography as the screening modality. However the true survival benefit of even mammographic screening has recently been questioned.
To compare breast cancer mortality following annual screening by two-view mammography and physical examination with screening by physical examination only.
Volunteer-based randomised trial of regular breast physical examination plus or minus regular mammography.
There was a clear increase in the detection of invasive breast cancer in the combined physical examination plus mammography group. During the screening rounds, 267 invasive cancers were found by mammography with physical examination compared with 148 detected by physical examination only. However the mortality rates, both breast-cancer specific and overall, were the same for the two groups. During the 13 year follow-up the difference in detection almost disappeared with 622 invasive and 71 in situ cancers detected by mammography with physical examination and 610 invasive and 16 in situ detected by physical examination only.
The authors refute the accusations from the ACR about the quality of some of the early mammograms, and point out that mammographic screening had no effect on the incidence of node-positive breast cancers. They liken this lead time effect without benefit to that of a similar unpublished observation in lung cancer, and suggest that earlier diagnosis of more advanced cancers by physical examination resulted in a survival advantage that was not further improved upon by the earlier mammographic detection of much lower risk cancers.
American%20College%20of%20Radiology criticisms of this study.
Edinburgh trial reports:
Alexander FE, Anderson TJ, Brown HK, Forrest AP, Hepburn W, Kirkpatrick AE, Muir BB, Prescott RJ, Smith A:14 years of follow-up from the Edinburgh randomised trial of breast-cancer screening. Lancet 1999, 353:1903-1908 (PubMed%20abstract)