Do the benefits of screening mammography outweigh the harms of overdiagnosis and unnecessary treatment?

Roder, David M; Olver, Ian N

doi:10.5694/mja11.11466

Topics

Yes. Public health adviser David Roder and Cancer Council Australia CEO Ian Olver believe the reduction in breast cancer mortality in Australia reflects both treatment and screening effects

All screening programs should be assessed for their benefits and risks, including the extent of overdiagnosis. Recently, Burton and colleagues concluded that almost 60% of the Australian decline in breast cancer mortality since 1991 could not be due to BreastScreen Australia (the free national mammographic program), attributing most of the decline to adjuvant hormonal and chemotherapy.1

1 Cancer Australia, Sydney, NSW.
2 Cancer Council Australia, Sydney, NSW.

Correspondence: ian.olver@cancer.org.au

Competing interests:

David Roder is employed by Cancer Australia and is part of a National Breast Cancer Foundation grant application to study overdiagnosis.

1. Burton RC, Bell RJ, Thiagarajah G, Stevenson C. Adjuvant therapy, not mammographic screening, accounts for most of the observed breast cancer specific mortality reductions in Australian women since the national screening program began in 1991. Breast Cancer Res Treat 2011; 29 Sep [Epub ahead of print].
2. Berry DA, Cronin KA, Plevritis SK, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 2005; 353: 1784-1792.
3. Roder D. Impact of population screening programs on cancer outcomes. Cancer Forum 2011. In press.
4. World Health Organization; International Agency for Research on Cancer. IARC handbooks of cancer prevention. Vol. 7: Breast cancer screening. Lyon: IARC Press, 2002.
5. Glasziou P, Houssami N. The evidence base for breast cancer screening. Prev Med 2011; 2 Jun [Epub ahead of print].

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