334
Letter to the Editor
Letter to the Editor European Journal of Cancer Prevention 2015, 24:334
Abolishing mammography screening programs? Jean-Luc Bulliarda, Carlo La Vecchiaa,b and Fabio Levia, aCancer Epidemiology Unit, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland and bDepartment of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy Correspondence to Fabio Levi, MD, Cancer Epidemiology Unit, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Corniche 10, 1010 Lausanne, Switzerland Tel: + 41 21 3147311; fax: + 41 21 3147317; e-mail: [email protected] Received 8 July 2014 Accepted 29 July 2014
Biller-Andorno and Jüni (2014), in a widely debated commentary published in the May 22 issue of the New England Journal of Medicine, accept the concept that mammography every 2 years from age 50 can decrease breast cancer mortality by 20%, that is, from five to four deaths per 1000 women over a 10-year period. Both the absolute and the relative risk of breast cancer death may vary depending on the baseline mortality rates in various populations and on the impact of screening mammography in reducing breast cancer mortality, which may well vary around the 20% estimate adopted. We accept, therefore, that there are still uncertainties in the absolute and relative impact of mammography screening on breast cancer mortality, given the different study schemes and mammography intervals, the differences in populations, and the continuous improvements in technology (Warner, 2011; Independent UK Panel on Breast Cancer Screening, 2012). We also agree on the observation that mammography has an appreciable impact on breast cancer mortality (Bosetti et al., 2012), but clearly a much smaller one on total mortality. A superficial reader of the perspective given by Biller-Andorno and Jüni (2014) would, however, be inclined to believe that the impact of mammography is minimal or negligible as these estimates (20% breast cancer mortality reduction or 1/1000 breast cancer deaths avoided over a 10-year period) are compared with those of a population survey on the subjective perception of
mammography (Domenighetti et al., 2003). The questions in that survey were formulated in a way that was prone to overestimation of the subjective perception of benefits of mammography and led therefore to a considerable and unrealistic overestimation of the benefit of mammography by the women interviewed (Bulliard and Levi, 2004; Dumalaon-Canaria et al., 2014). In any case, such perceptions are not comparable with the accumulated, quantitative evidence on the favorable effects of mammography on breast cancer mortality, and cannot obscure such a widely recognized effect now.
Acknowledgements Conflicts of interest
F.L. is a member of the Bureau and Council of the mammography breast cancer screening program of the canton of Vaud. F.L. and J.-L.B. have received mandates from public funding sources for the evaluation of several cantonal programs and the first national monitoring report of breast cancer screening. C.L.V. has no conflicts of interest.
References Biller-Andorno N, Jüni P (2014). Abolishing mammography screening programs? A view from the Swiss Medical Board. N Engl J Med 370:1965–1967. Bosetti C, Bertuccio P, Levi F, Chatenoud L, Negri E, La Vecchia C (2012). The decline in breast cancer mortality in Europe: an update (to 2009). Breast 21:77–82. Bulliard JL, Levi F (2004). Women’s perception of mammography screening. Int J Epidemiol 13:903–904. Domenighetti C, D’Avanzo B, Egger M, Berrino F, Perneger T, Mosconi P, Zwahlen M (2003). Women’s perception of the benefits of mammography screening: population-based survey in four countries. Int J Epidemiol 32:816–821. Dumalaon-Canaria JA, Hutchinson AD, Prichard I, Wilson C (2014). What causes breast cancer? A systematic review of causal attributions among breast cancer survivors and how these compare to expert-endorsed risk factors. Cancer Causes Control 25:771–785. Independent UK Panel on Breast Cancer Screening (2012). The benefits and harms of breast cancer screening: an independent review. Lancet 380:1778–1786. Warner E (2011). Clinical practice. Breast cancer screening. N Engl J Med 365:1025–1032.
0959-8278 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
DOI: 10.1097/CEJ.0000000000000082
Letter to the Editor
Letter to the Editor European Journal of Cancer Prevention 2015, 24:334
Abolishing mammography screening programs? Jean-Luc Bulliarda, Carlo La Vecchiaa,b and Fabio Levia, aCancer Epidemiology Unit, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland and bDepartment of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy Correspondence to Fabio Levi, MD, Cancer Epidemiology Unit, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Corniche 10, 1010 Lausanne, Switzerland Tel: + 41 21 3147311; fax: + 41 21 3147317; e-mail: [email protected] Received 8 July 2014 Accepted 29 July 2014
Biller-Andorno and Jüni (2014), in a widely debated commentary published in the May 22 issue of the New England Journal of Medicine, accept the concept that mammography every 2 years from age 50 can decrease breast cancer mortality by 20%, that is, from five to four deaths per 1000 women over a 10-year period. Both the absolute and the relative risk of breast cancer death may vary depending on the baseline mortality rates in various populations and on the impact of screening mammography in reducing breast cancer mortality, which may well vary around the 20% estimate adopted. We accept, therefore, that there are still uncertainties in the absolute and relative impact of mammography screening on breast cancer mortality, given the different study schemes and mammography intervals, the differences in populations, and the continuous improvements in technology (Warner, 2011; Independent UK Panel on Breast Cancer Screening, 2012). We also agree on the observation that mammography has an appreciable impact on breast cancer mortality (Bosetti et al., 2012), but clearly a much smaller one on total mortality. A superficial reader of the perspective given by Biller-Andorno and Jüni (2014) would, however, be inclined to believe that the impact of mammography is minimal or negligible as these estimates (20% breast cancer mortality reduction or 1/1000 breast cancer deaths avoided over a 10-year period) are compared with those of a population survey on the subjective perception of
mammography (Domenighetti et al., 2003). The questions in that survey were formulated in a way that was prone to overestimation of the subjective perception of benefits of mammography and led therefore to a considerable and unrealistic overestimation of the benefit of mammography by the women interviewed (Bulliard and Levi, 2004; Dumalaon-Canaria et al., 2014). In any case, such perceptions are not comparable with the accumulated, quantitative evidence on the favorable effects of mammography on breast cancer mortality, and cannot obscure such a widely recognized effect now.
Acknowledgements Conflicts of interest
F.L. is a member of the Bureau and Council of the mammography breast cancer screening program of the canton of Vaud. F.L. and J.-L.B. have received mandates from public funding sources for the evaluation of several cantonal programs and the first national monitoring report of breast cancer screening. C.L.V. has no conflicts of interest.
References Biller-Andorno N, Jüni P (2014). Abolishing mammography screening programs? A view from the Swiss Medical Board. N Engl J Med 370:1965–1967. Bosetti C, Bertuccio P, Levi F, Chatenoud L, Negri E, La Vecchia C (2012). The decline in breast cancer mortality in Europe: an update (to 2009). Breast 21:77–82. Bulliard JL, Levi F (2004). Women’s perception of mammography screening. Int J Epidemiol 13:903–904. Domenighetti C, D’Avanzo B, Egger M, Berrino F, Perneger T, Mosconi P, Zwahlen M (2003). Women’s perception of the benefits of mammography screening: population-based survey in four countries. Int J Epidemiol 32:816–821. Dumalaon-Canaria JA, Hutchinson AD, Prichard I, Wilson C (2014). What causes breast cancer? A systematic review of causal attributions among breast cancer survivors and how these compare to expert-endorsed risk factors. Cancer Causes Control 25:771–785. Independent UK Panel on Breast Cancer Screening (2012). The benefits and harms of breast cancer screening: an independent review. Lancet 380:1778–1786. Warner E (2011). Clinical practice. Breast cancer screening. N Engl J Med 365:1025–1032.
0959-8278 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
DOI: 10.1097/CEJ.0000000000000082
