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Mortality Benefit from Mammography Screening? Norway Weighs In — Physician’s First Watch

Medical News |
June 18, 2014

Mortality Benefit from Mammography Screening? Norway Weighs In

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH

Biennial screening mammography is associated with a significant reduction in breast cancer mortality, according to an observational study in BMJ. Editorialists, however, call the reduction "modest at best."

Researchers examined data on all women in Norway who were aged 50 to 79 during 1986 to 2009, when the country gradually implemented a mammography screening program. During more than 15 million person-years of observation, nearly 1200 women who were invited to biennial screening died from breast cancer, versus 9000 who were not yet invited. After multivariable adjustment, invitation to screening was associated with a 28% reduced risk for breast cancer mortality.

The researchers calculated that 368 women aged 50 to 69 would need to be invited for biennial screening to prevent one breast cancer death.

Andrew Kaunitz of NEJM Journal Watch Women's Health advises: "As we counsel women regarding the pros and cons of mammography, a modest mortality reduction needs to be weighed against harms including overdiagnosis, emotional stress, and the high costs associated with widespread screening."

Reader Comments (8)

ORTIZ-PEREZ VICENTE Physician, Obstetrics/Gynecology, Ofiice

A 37% reduction in mortality is a great reduction, no modest This article shows that the preventive medicine is yet the mos cheaper, the most effective and the less painfull.

CAROL VASSAR Physician, Internal Medicine, pvt practice

$80,000. per quality year of life- for one screening procedure. Add in colonoscopy, PAP, smear, DEXA and any other screening procedures/tests. How much can we afford per year. The average income in the US is less than $80,000.

37% and 28% whichever you pick is a relative risk reduction. What is the absolute risk reduction? the 368 women to save one life for 50-69 is better than the 1700 needed age 50-60 in the US to save a life.

1200 vs 9000 sounds impressive but what is the total population of women?

Benefits always need to be balanced with the risks. That one third of women treated for breast cancers diagnosed by mammogram would never have known they had breast cancer, it never would have become apparent, is a very sobering risk.

This is not the first study published in the last 2 years looking at mammograms, benefits and risks. This one finds greater benefits than several of the other studies. No single study, especially an observational study is going to provide the answer. We all want to save women's lives, but we don't want to harm others who would never have been harmed by their cancer. What we have learned from the studies of breast cancer screening and prostate cancer screening is that cancers are not all equal. They don't all kill. Far more of us develop cancer than would ever become aware of our cancer.

Sean Flynn, MD Physician, Radiology

I never--this is my first time--respond or comment on Journal Watch reviews and I have been a subscriber since 1999. However, the tone of reviews has become decidedly jaundiced against mammography since 2009. Previously in reviews, the author would summarize and state an opinion in the last paragraph so as not to bias the reader. To put editorial opinion in the second line of a review is unprofessional and just poor form showing a true lack of experience. Since when is a 37% improvement in outcomes in any medical study considered moderate! We are happy with a new cancer medication when it provides a 5% increase in survival--and costs over $10,000 per dose--, and yet a tool(costing $250-400) that has consistently shown to have a 20-30% mortality improvement in all studies not Canadian or published by statisticians, it gets bashed for too inaccurate and expensive. You have one(Dr. Kopans) of the most knowledgable men on the planet regarding mammography in your own backyard. I suggest you consult with him before reviewing any further mammography studies.

Ana Peixoto Resident, Family Medicine/General Practice

Even if you save just one life is enough; specially for an economy as Norway has! I don't even understand why they want to spend less with screening cancer diseases! As a women I would like to have the right to do this test!

Michele Royalty PharmD, MPH Other Healthcare Professional, Oncology, Retired

I would like to see the calculation for $ per year of life saved. A mammogram is inexpensive, if the life saved lived 20 years, mammogram cost $500 per year, 10 years of screening, is would ballpark at $80,000 per year of life saved, well within accepted medical costs.

Jane Aswell, Ph.D. Other, Infectious Disease, Wake Technical Community College

In reading the actual article, there was a 37% reduction in mortality versus those who did not attend. Are you kidding me? This is not a "modest mortality reduction"! Is money more important than a 37% reduction in mortality? I am wondering why there seems to be a movement against routine mammography as outlined in this very important article.

Reilly, Tina Other Healthcare Professional, Pediatrics/Adolescent Medicine

1200 vs 9000 is modest at best? That seems insulting to the women it saved and the woman who died. I am sure the emotional stress of dying and the cost of breast cancer treatment for those that were delayed in diagnosing should be considered as well.

YAMIN COHEN
Competing Interests: Breast Imager

I am astounded by Andrew Kaunitz of NEJM Journal Watch Women's Health - comments
Even when the data shows the benefits of screening mammography some people will never be convinced!Is it perhaps that not matter what the scientific data shows- if the party line is anti-screening mammography (ie.NEJM) then it must be towed.
How shameful!

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