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Screening mammography controversies: resolved, partly resolved, and unresolved
1Department of Radiology, Mount Sinai Hospital, Mount Sinai School of Medicine, New York, NY 10029-6574, USA. stephen.feig@mountsinai.org
The Breast Journal
|February 24, 2005
Summary
Annual screening mammography for women aged 40 and older significantly reduces breast cancer deaths. Despite controversies, evidence strongly supports its continued use for early detection and improved outcomes.
Area of Science:
- Oncology
- Radiology
- Public Health
Background:
- Multiple randomized clinical trials since the 1960s have evaluated screening mammography's impact on breast cancer mortality in women aged 40-70.
- Recent analyses of Swedish studies have questioned the benefits of screening mammography, citing no reduction in overall mortality.
- Controversies include risks like radiation exposure, overdiagnosis of ductal carcinoma in situ (DCIS), and high callback rates.
Purpose of the Study:
- To review and assess the evidence from randomized clinical trials on screening mammography for breast cancer.
- To critically evaluate recent claims challenging the efficacy of mammography screening.
- To address current controversies surrounding screening mammography and provide an evidence-based recommendation.
Main Methods:
- Review of multiple randomized clinical trials comparing breast cancer mortality in women offered screening mammography versus control groups.
- Critical assessment of published articles analyzing screening mammography studies, particularly those from Sweden.
- Evaluation of potential adverse consequences and risks associated with screening mammography.
Main Results:
- Nearly all historical randomized trials documented statistically significant reductions in breast cancer deaths among women offered screening mammography.
- These trials may have underestimated the true benefit due to non-optimized screening parameters.
- Critical review of recent studies found that breast cancer deaths constituted <5% of all deaths, making overall mortality reduction statistically unlikely in the analyzed populations.
Conclusions:
- The overwhelming scientific evidence strongly supports annual screening mammography for women aged 40 and older.
- Despite ongoing controversies and potential risks, the mortality benefits of mammography screening remain evident.
- Continued adherence to screening guidelines is recommended for early breast cancer detection and improved patient outcomes.