BMJ 2015;350:h3055 doi: 10.1136/bmj.h3055 (Published 4 June 2015)
Page 1 of 2
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NEWS Benefits of mammography in women aged 50-69 outweigh risks, says expert panel Susan Mayor London
The benefits of mammography screening in terms of reduced breast cancer mortality in women aged 50-69 more than outweigh the risks, including false positive results and the effects of radiation exposure, a report has found.1
An expert panel convened by the International Agency for Research on Cancer compiled the report after reviewing the available evidence. The group of 29 independent experts from 16 countries assessed methods of screening for breast cancer in terms of their efficacy in preventing cancer and of their adverse effects. They reviewed all published studies of each type of screening, recognising that trials published more than 20 years ago may now be out of date because screening methods and treatments for breast cancer have improved.
Their review, summarised in the New England Journal of Medicine,1 found sufficient evidence that mammography screening was effective in reducing breast cancer mortality in women aged 50-69. Evaluating data from 20 cohort studies and 20 case control studies in high income countries showed that women in this age group who attended mammography screening had around 40% lower breast cancer mortality than women who were not screened. The group considered that the benefit of reduced mortality extended to older women screened from age 70-74, on the basis of a smaller number of studies. But they found insufficient evidence to assess the effect of mammography screening on breast cancer mortality in younger women aged 40-49.
In terms of harms, the review found that the cumulative risk of false positive results was about 20% in organised mammography
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screening programmes for a woman who had 10 screens from age 50-70. Less than 5% of all positive screens resulted in invasive procedures, but the group considered that having a false positive mammogram had short term negative psychological consequences in some women. They found that the risk of overdiagnosis was 6.5% (range 1% to 10%) on the basis of studies in Europe and that the risk of death due to radiation from mammographic screening was 1-10 in 100 000 women, depending on age and the frequency of screening.
“Careful consideration of both the benefits and harms of mammography screening shows a net benefit from inviting women 50-69 years old,” concluded Béatrice Lauby-Secretan, lead author, from the International Agency for Research on Cancer.
Looking at other types of screening, the group found evidence that breast cancer screening by physical examination was associated with detecting smaller and earlier stage tumours but no data on the effect of this on breast cancer mortality. Also, studies on breast self examination did not show reduced breast cancer mortality. The group’s recommendations will be published in full in an update of the agency’s 2002 handbook of cancer prevention (www.iarc.fr). 1
Lauby-Secretan B, Scoccianti C, Loomis D, et al. Breast cancer screening—viewpoint of the IARC working group. NEJM 2015; doi:10.1056/NEJMsr1504363.
Cite this as: BMJ 2015;350:h3055 © BMJ Publishing Group Ltd 2015
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BMJ 2015;350:h3055 doi: 10.1136/bmj.h3055 (Published 4 June 2015)
Page 2 of 2
NEWS
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Page 1 of 2
News
NEWS Benefits of mammography in women aged 50-69 outweigh risks, says expert panel Susan Mayor London
The benefits of mammography screening in terms of reduced breast cancer mortality in women aged 50-69 more than outweigh the risks, including false positive results and the effects of radiation exposure, a report has found.1
An expert panel convened by the International Agency for Research on Cancer compiled the report after reviewing the available evidence. The group of 29 independent experts from 16 countries assessed methods of screening for breast cancer in terms of their efficacy in preventing cancer and of their adverse effects. They reviewed all published studies of each type of screening, recognising that trials published more than 20 years ago may now be out of date because screening methods and treatments for breast cancer have improved.
Their review, summarised in the New England Journal of Medicine,1 found sufficient evidence that mammography screening was effective in reducing breast cancer mortality in women aged 50-69. Evaluating data from 20 cohort studies and 20 case control studies in high income countries showed that women in this age group who attended mammography screening had around 40% lower breast cancer mortality than women who were not screened. The group considered that the benefit of reduced mortality extended to older women screened from age 70-74, on the basis of a smaller number of studies. But they found insufficient evidence to assess the effect of mammography screening on breast cancer mortality in younger women aged 40-49.
In terms of harms, the review found that the cumulative risk of false positive results was about 20% in organised mammography
For personal use only: See rights and reprints http://www.bmj.com/permissions
screening programmes for a woman who had 10 screens from age 50-70. Less than 5% of all positive screens resulted in invasive procedures, but the group considered that having a false positive mammogram had short term negative psychological consequences in some women. They found that the risk of overdiagnosis was 6.5% (range 1% to 10%) on the basis of studies in Europe and that the risk of death due to radiation from mammographic screening was 1-10 in 100 000 women, depending on age and the frequency of screening.
“Careful consideration of both the benefits and harms of mammography screening shows a net benefit from inviting women 50-69 years old,” concluded Béatrice Lauby-Secretan, lead author, from the International Agency for Research on Cancer.
Looking at other types of screening, the group found evidence that breast cancer screening by physical examination was associated with detecting smaller and earlier stage tumours but no data on the effect of this on breast cancer mortality. Also, studies on breast self examination did not show reduced breast cancer mortality. The group’s recommendations will be published in full in an update of the agency’s 2002 handbook of cancer prevention (www.iarc.fr). 1
Lauby-Secretan B, Scoccianti C, Loomis D, et al. Breast cancer screening—viewpoint of the IARC working group. NEJM 2015; doi:10.1056/NEJMsr1504363.
Cite this as: BMJ 2015;350:h3055 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
BMJ 2015;350:h3055 doi: 10.1136/bmj.h3055 (Published 4 June 2015)
Page 2 of 2
NEWS
Figure
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
