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Sorting Out the Value of Mammography

Analysis of paired European countries suggests screening has little effect on breast cancer mortality.

Mortality from invasive breast cancer continues to fall in North America, Australia, and most western European countries. To assess the relative effects on breast cancer mortality of mammographic screening and improved treatment, investigators paired selected European countries based on geographic contiguity, socioeconomic status, and quality of and access to healthcare services. For each of three pairs (Sweden and Norway; the Netherlands and Belgium; Northern Ireland [U.K.] and the Republic of Ireland), nationwide mammographic screening had been implemented by 1990 in the first country and substantially later in the second. Breast cancer mortality was compared for each pair.

For example, national screening mammography was initiated in the mid-1980s in Sweden (countrywide coverage achieved by 1997) and the mid-1990s in Norway (countrywide coverage achieved by 2005). Despite the later introduction of screening in Norway, breast cancer mortality between 1989 and 2006 declined by 16% in Sweden and by 24% in Norway. Similar trends were observed in the other paired countries.

Comment: This analysis of breast cancer mortality contrasts with a similar study of cervical cancer in Scandinavia: Although access to surgery and radiation therapy was comparable among all Nordic countries from 1965 through 1980, large reductions in cervical cancer mortality during this period were observed in countries with nationwide cytology screening but not in countries with delayed implementation of such screening. Authors of another recent study (JW Womens Health Sep 22 2010) have also made a credible argument that screening mammography plays a limited role in lowering breast cancer mortality. Improvements in breast cancer management (and access to treatment) seem to be more important. Overall, these observations should help clinicians to be comfortable adopting a flexible approach to when and how often women choose to be screened (JW Womens Health Jul 28 2011).

— Andrew M. Kaunitz, MD

Published in Journal Watch Women's Health August 11, 2011

Citation(s):

Autier P et al. Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: Trend analysis of WHO mortality database. BMJ 2011 Jul 28; 343:d4411. (http://dx.doi.org/10.1136/bmj.d4411)

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• Mammography
  K THomas Bose, M.D. BOSE, 12 Aug 2011 12:50 PM EST
  Specialty: Radiology
  This is a misleading article with very little statistics and contradicting many scientific papers. It is true that the decrease... [more]

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