Special lecture: the breast cancer screening controversy: a perspective

Analysis of the data of the Health Insurance Plan of New York Breast Cancer Screening Study indicates that in patients whose cancers were found by screening, the case fatality rate at all ages is almost half the case fatality rate of controls. The data also strongly suggest that maximal benefit in young women resides in the detection of in situ cancers. Due to relatively low yield of these early lesions, projected 20 year survival in that study may be little different for all women screened compared to controls. We have shown that the yield of these early lesions can be increased by aggressive screening and liberal use of biopsy. Furthermore, where J.C. Bailar has indicated a net gain (or loss) of -4 to +8 lives per 20,000 women using the HIP data, using his method and our data we find a savings of 25-27 lives/20,000 women by 3 year screening to date. These are lives that have been saved by mammography alone.