The evidence to support mammography screening

A recent Cochrane review claimed that mammography screening did not save lives and could actually be harmful. In an advisory report to the Dutch government, a committee of the Health Council of The Netherlands concludes that the Cochrane review does not nullify the evidence supporting breast cancer screening programmes for women aged 50 or over. Except for one flawed trial, the committee found no convincing arguments to exclude four out of the six other eligible trials entirely or partially from the analysis. The committee considers the reviewers' conclusions that breast cancer mortality as an outcome is unreliable (biased in favour of screening) and must be replaced by overall mortality to be too extreme. In the committee's view, breast cancer mortality is an important outcome. However, this outcome should be considered in conjunction with all-cancer mortality and all-cause mortality when interpreting the results of screening trials (or observational studies).