The benefits and harms of breast cancer screening: an independent review

Marmot, Michael; Altman, Douglas G.; Cameron, David; Dewar, John; Thompson, Simon G.; Wilcox, Michael

doi:10.1038/bjc.2013.177

Cited by 895 publications

(873 citation statements)

References 237 publications

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“…Our benefit‐to‐harm ratio was more in favor of screening than the results from the Marmot report12 and from the Norwegian Breast Cancer Screening Program,2 but similar to results reported by Duffy et al 13. and the EUROSCREEN group 1…”

Section: Discussionsupporting

confidence: 88%

“…The reductions in breast cancer mortality varied from 20% in the Marmot report12 to 32% from the Two County Study 13. This reflected that the Marmot report used all RCTs, including the two Canadian outliers,15, 16 and that the Two County Study was the single RCT with the largest reduction in breast cancer mortality.…”

Section: Discussionmentioning

confidence: 99%

“…The Marmot report12 used results from the randomized controlled trials (RCTs) to estimate the benefit and risk of breast cancer screening. For every 1,000 women invited to screening, 4.3 breast cancer deaths would be prevented and 12.9 cases would be overdiagnosed.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, for every 1,000 women screened, 5.6 breast cancer deaths would be prevented and 16 cases would be overdiagnosed, leading to a ratio of 0.35. While the impact of screening on breast cancer mortality was estimated based on all nine RCTs, overdiagnosis was estimated only from the three RCTs “that did not systematically screen the control group at the end of the screening period.”12 However, even these RCTs were not well suited for estimation of overdiagnosis 14. In the Malmö RCT, the excess cumulative breast cancer incidence derived exclusively from women screened on average to age 76.5, which left limited time for post‐screening follow‐up.…”

Section: Discussionmentioning

confidence: 99%

“…We used only estimates, where there was correspondence between the percentage of overdiagnosis reported and the age‐group to which this percentage was applied. In the Marmot report, the numbers were given for women aged 50 years and followed for 20 years 12. In the Two County Study for women aged 50–69 years at randomization,13 in the English data for women aged 45 and above,13 while both the Norwegian2 and the EUROSCREEN1 studies used data for women aged 50–79 years, as we did.…”

Section: Discussionmentioning

confidence: 99%

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Benefit-to-harm ratio of the Danish breast cancer screening programme

et al. 2017

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The primary aim of breast cancer screening is to reduce breast cancer mortality, but screening also has negative side‐effects as overdiagnosis. To evaluate a screening programme, both benefits and harms should be considered. Published estimates of the benefit‐to‐harm ratio, the number of breast cancer deaths prevented divided by the number of overdiagnosed breast cancer cases, varied considerably. The objective of the study was to estimate the benefit‐to‐harm ratio of breast cancer screening in Denmark. The numbers of breast cancer deaths prevented and overdiagnosed cases [invasive and ductal carcinoma in situ (DCIS)] were estimated per 1,000 women aged 50–79, using national published estimates for breast cancer mortality and overdiagnosis, and national incidence and mortality rates. Estimations were made for both invited and screened women. Among 1,000 women invited to screening from age 50 to age 69 and followed until age 79, we estimated that 5.4 breast cancer deaths would be prevented and 2.1 cases overdiagnosed, under the observed scenario in Denmark of a breast cancer mortality reduction of 23.4% and 2.3% of the breast cancer cases being overdiagnosed. The estimated benefit‐to‐harm ratio was 2.6 for invited women and 2.5 for screened women. Hence, 2–3 women would be prevented from dying from breast cancer for every woman overdiagnosed with invasive breast cancer or DCIS. The difference between the previous published ratios and 2.6 for Denmark is probably more a reflection of the accuracy of the underlying estimates than of the actual screening programmes. Therefore, benefit‐to‐harm ratios should be used cautiously.

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