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Mammograms and Mortality: How Has the Evidence Evolved?
1Applied Economics and Public Policy, University of Michigan, Ann Arbor, Michigan.
The Journal of Economic Perspectives : a Journal of the American Economic Association
|August 23, 2021
Summary
Mammograms can detect breast cancer early, but may also lead to overdiagnosis and overtreatment of non-progressive cancers. Evidence evolution impacts mammography guidelines and mortality considerations.
Area of Science:
- Oncology
- Preventive Medicine
- Biostatistics
Background:
- Mammography's role in breast cancer screening is debated due to complex effects on mortality.
- Evidence suggests mammograms can detect cancers early but also lead to overdiagnosis and overtreatment.
Purpose of the Study:
- To review the historical evidence on mammograms and mortality, focusing on clinical trials.
- To examine how this evidence influences current mammography guidelines.
- To analyze trends in all-cause and breast cancer mortality within a key clinical trial.
Main Methods:
- Systematic review of clinical trial evidence on mammography and mortality.
- Analysis of mortality data (all-cause and breast cancer-specific) from a significant clinical trial.
- Discussion of the evolution of evidence and its impact on screening recommendations.
Main Results:
- Mammograms have a complex relationship with mortality, offering early detection benefits alongside risks of overdiagnosis.
- Clinical trial evidence has shaped evolving mammography guidelines over decades.
- Analysis of a key trial shows shifts in relative mortality rates, prompting reevaluation.
Conclusions:
- The evidence on mammograms and mortality necessitates careful consideration in screening guidelines.
- Overdiagnosis and overtreatment remain significant concerns in breast cancer screening.
- Ongoing evaluation of evidence is crucial for refining mammography recommendations and patient care.
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