To the Editor: Although both sides of the debate about screening mammography1,2 acknowledge the mortality benefit due to screening and the risk of overdiagnosis, the magnitude and relative value of these need further clarification and reflection. In calculating the number of breast cancer deaths averted using a relative risk reduction of 35%, Roder and Olver overstate the benefit. Other estimates of effect are lower (eg, 15%,3 16% [all ages] and 22% [> 50 years],4 and 19%5) and lead to a calculation of fewer averted deaths.
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- 1. Roder DM, Olver IN. Do the benefits of screening mammography outweigh the harms of overdiagnosis and unnecessary treatment? — Yes [opposing views]. Med J Aust 2012; 196: 16. <MJA full text>
- 2. Bell RJ, Burton RC. Do the benefits of screening mammography outweigh the harms of overdiagnosis and unnecessary treatment? — No [opposing views]. Med J Aust 2012; 196: 17. <MJA full text>
- 3. Gotzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database Syst Rev 2011; (1): CD001877.
- 4. Humphrey LL, Helfand M, Chan BK, Woolf SH. Breast cancer screening: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002; 137: 347-360.
- 5. Glasziou P, Houssami N. The evidence base for breast cancer screening. Prev Med 2011; 2 Jun [Epub ahead of print].
- 6. Morrell S, Barratt A. Irwig L, et al. Estimates of overdiagnosis of invasive breast cancer associated with screening mammography. Cancer Causes Control 2010; 21: 275-282.
- 7. Kalager M, Adami HO, Bretthauer M, Tamimi RM. Overdiagnosis of invasive breast cancer due to mammography screening: results from the Norwegian Screening Program. Ann Intern Med 2012; 156: 491-499.
- 8. Jørgensen KJ, Gøtzsche PC. Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends. BMJ 2009; 339: b2587. doi: 10.1136/bmj.b2587.
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