Breast cancer screening: commentary and conclusions.

摘要

None of the authors of this collection of invited papers on Breast Cancer Screening have seriously challenged the conclusion of the US Preventive Services Task Force (2009) that screening mammography should not be offered routinely to women age 40-49, and that it should be offered no more frequently than biennially to older women.However, several aspects of my questions (as listed in the Introduction) were not specifically addressed. Thus my question 1 ("Have all the concerns raised by some of the critics of the trials of breast cancer screening been adequately addressed by re-analyses that answer these concerns?") did not elicit any comment. I suspect this is because the response is largely in the negative. For example, in a recent update of the Swedish Two-County trial - where only three screens were used and then screening was offered to the controls - the authors simply ignored previous criticisms of their trial (Tabar et al., 2011). The report, published after any of the authors could have accessed it, shows a widening effect of mammography screening with time in this cluster-randomized trial and suggests that a basic imbalance between the groups was responsible for most if not all of the effect claimed for mammography screening.