Annual Screening Mammography Produces Overdiagnoses, No Mortality Benefit — Physician’s First Watch

Medical News |
February 12, 2014

Annual Screening Mammography Produces Overdiagnoses, No Mortality Benefit

By Joe Elia

Annual mammography screening in women under age 60 does not confer a breast cancer mortality advantage, and it results in more than 20% overdiagnosis among the lesions found, according to a follow-up of the Canadian National Breast Screening Study.

As reported in BMJ, between 1980 and 1985, some 90,000 women aged 40 to 59 were randomized to 5 years of annual mammography or no mammography (women aged 40-49 in the mammography group and all women aged 50-59 received annual physical breast examinations).

After up to 25 years' follow-up, there was no discernible difference between groups in breast cancer mortality. Of the screen-detected tumors, 22% were overdiagnoses — one for every 424 women in the mammography arm.

Andrew Kaunitz, an OB/GYN with NEJM Journal Watch, comments: "This important Canadian report documents the failure of screening mammography to impact mortality from breast cancer, as well as breast cancer overdiagnosis. Based on these and other recently published data, clinicians and women should move away from starting screens among women in their 40s and from screening annually. While we reevaluate the practice of screening mammography, adopting the U.S. Preventive Services Task Force 2009 recommendations (beginning screening in average-risk women at age 50 and screening biennially) would appear prudent."

Reader Comments (10)

R FURIGAY Physician, Surgery, General

I agree totally with this study .

CAROL VASSAR Physician, Internal Medicine, private practice, Vermont

One of the unnoticed outcomes of this study is the importance of clinical breast exam. All of these women were screened with clinical breast exam. The mammogram offered no survival benefit beyond the clinical breast exam. This would fit with the danger of over diagnosis with mammography of breast cancers so small that they could not be found on exam.

Matt Arvon, D.O. Physician, Surgery, Specialized

I feel that this study, produced by a country with socialized medicine will likely be used to push the message that our government funded system will no longer need to pay for health screenings because such screenings are of no benefit...tell that to a breast cancer survivorn or prostate cancer survivor...Canadians also reported no benefit from PSA screening...which resulted changes to government screening recommendations...It is no surprise to me that the government funded "study" finds little to no benefit to spending government funds on screenings...We are next...we are now...and no, I do not drink kool-aid, go to tea parties or believe Kennedy was shot by 6 people...just hesitant to jump on the screen cutting bandwagon based on what is possibly a biased "study".

Phil Grimm, MD Physician, Radiology, Southern Oregon

The problem with mammography is that you only see the smoke, and you never see the fire.

The only people in my group comfortable with screening mammography were those who had a reputation of being overcallers. The only thing that even slowed those guys down a little was when their own wives were caught in the trap of an overcalled lesion. After about six months the overcallers went back to their excessively vigilant ways.

Duy,Vu M.D. Physician, Oncology, sick leave

most of this type of report has one flaw: it doesn't reflect all the risks of breast cancer. It stratifies the studied population by age trend; other factors are not taken into consideration such as gene, environment, nutrition. In the era of big data this type of study obviously needs a lot of improvement and refinement, otherwise we started to reinvent the wheel.

Hidemi Furusawa Physician, Surgery, Specialized, Breastopia Hospital

Absolutely I agree with this paper especially in average asian women under 60yo.

Lee K Finklea Sr MD Physician, Pediatrics/Adolescent Medicine, Retired

Life is rarely absolutely clear cut

HERSCHEL FISCHER Physician, Emergency Medicine, retired

---what are the actual numbers for the 40-49 group who received no mammograms during this period.....?
....were they studied only after a lesion was palpable?....

ROBERT WEIN Physician, Obstetrics/Gynecology, Greensboro, NC

As long as our professional medical organizations recommend yearly mammograms after 40, the Bar Associations will continue to hold us to those standards.

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