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Thursday, March 25, 2010

More data on the uselessness of screening

A Danish study looking at the effectiveness of screening mammography in a n asymptomatic population of women.

Key points:
Dr. Jørgensen and his team analyzed and compared data from the regions with screening and those without and found:
In the 55-to-74 age group, breast-cancer mortality declined by 1 per cent annually in areas with screening and 2 per cent a year in areas where there was no screening;
In the 35-to-54 age group, where screening is not recommended, breast-cancer mortality fell 5 per cent a year in areas with screening and 6 per cent in those without.
In the 75-and-over age group, there was no change in mortality in any area.
Breast-cancer mortality dropped steadily in the 10 years prior to screening beginning.

I don't expect that this will alter behavior of physicians and patients quickly but I will be interested in seeing the landscape in five years. Either we will witness a gradual erosion on the number of patients who get screening mammography, or the entire literature will be forgotten. What will make a difference is if payment for the services makes their delivery a money loser. Then the enthusiasm for the activity will fall precipitously.


  1. Excellent article on the topic of screening mammography. I was actually impressed at the level of the information. Many of the points have been raised over the years by other critics of screening mammography, and in my opinion, valid criticisms.

    Especially disturbing is that mammography screening generates large numbers of procedures, biopsies and surgeries, with little impact on the numbers of advanced breast cancers. This point was raised
    by Laura Esserman in her JAMA article. This new study by Karsten Juhl Jørgensen, M.D., of the University of Copenhagen in Denmark is very supportive of Dr Esserman's conclusions.

    One looming issue is the large numbers of DCIS detected by mammography as
    small calcifications. Although DCIS is treated aggressively as an invasive cancer, it is really very indolent. DCIS has a 98% -5 year survival with no treatment, and pathologists have been thinking about changing the nomenclature by removing the word "cancer" from its name.

    For more:

    jeffrey dach md

  2. Question: Has there ever been a comparative study of the mortality rates of the same histological type of breast CA diagnosed by screening mammography vs. detected clinically either by self or professional examination?

  3. Patients would be shocked and enlightened at how modest the benefits of mammography are to individual patients. Their benefit is apparent when studying populations, as is true for many screening tests, but this translates into only a slight benefit to the person before us. Exaggeration and hype are commonplace in the medical world.