UK Experts Question Usefulness of Screening Mammograms


The American Cancer Society recommendations for early breast cancer detection in women without breast symptoms suggests “Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health.” The ACS feels that these screening mammograms save the lives of approximately 15% of women who are diagnosed with breast cancer by finding the cancer early.

Two British doctors, John Keen and James Keen, has published a paper in the open access journal BMC Medical Informatics and Decision Making that disputes that number. They feel that fewer than 5 percent of all women whose breast tumors can be detected through screening actually have their lives saved by a mammogram.

The study was done to analyze the claim "mammography saves lives." The researchers calculated the absolute benefit by first estimating the screen-free absolute death risk from breast cancer. They used data from the Surveillance, Epidemiology and End Results Program. They then calculated the absolute risk reduction (reduction in absolute death risk), the number needed to screen assuming repeated screening, and the survival percentages without and with screening.

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They feel that only 1.8 lives are saved in women with repeated screening over 15 years,beginning at age 50 yr of age, for every 1000 women screened. The found the survival percentage to be 99.12% without and 99.29% with screening. They feel that less than 5% of women with screen-detectable cancers have their lives saved.

This then continues the debate of the usefulness and cost-effectiveness of screening mammograms. Dr Michael Retsky of Harvard Medical School praised the study in an accompanying commentary. He writes “Too often women aged 40 to 49 are invited to have mammograms without being properly informed of the risks.” Others, like Prof Julietta Patnick, Director of the NHS Cancer Screening Programmes, respond by stating that their group has "has calculated that the programme saves 1 life for every 8 cancers detected."

This study is not likely to settle the question, so each woman should make her own decision. She should talk to her doctor and weigh her own family history and risk.

"What is the point: will screening mammography save my life?."; BMC Medical Informatics and Decision Making 2009, 9:18 (doi:10.1186/1472-6947-9-18); John D Keen and James E Keen
American Cancer Association