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Questions Regarding the Benefits of Mammograms

The article pulished on February 11, 2014 in the BMJ entitled Twenty-five Year Follow up for Breast Cancer Incidence and Mortality of the Canadian National Breast Screening Study: a randomised Screening Trial has stirred confusion and concerns about the need for routine screeing mammograms in the fight against breast cancer.


This study was an update on the orginal study and was one that the US Preventive Services Task Force (USPSTF) cited in its 2009 guideline upadates.


This study's conclusion states that annual mammography for women between the ages of 40-59 does not reduce mortality beyond that of physical examination and usual care.


I am concerned that this conclusion that has been aired on many news casts will deter women in this age group from obtaining a life saving test.  There are several flaws in the study which brings into question the validity of the conclusion. The authors of the study admit and discuss some of these concerns including selection bias and the effects of the "usual care in the community."  Women should note that this article does further state that women with non-palpable breast cancer detected by mammography expierence superior long-term survival compared to those diagnosed with palpable breast cancer.  The authors state the reason for this is not clear and possibly due to lead time bias or overdiagnosis. I believe more study is definitely needed on this important health issues. However, in the interim the well known fact that earlier detection leads to a better prognosis will not alter my recommendations for screening mammography.


You may read the full article at



Kathleen M. Curtis MD