|Canadian National Breast Screening Study-2: 13-Year Results of a Randomized Trial in Women Aged 50-59 Years|
|Anthony B. Miller, Teresa To, Cornelia J. Baines, et al.|
|Abramson Cancer Center of the University of Pennsylvania|
| Last Modified: November 1, 2001
Reviewers: Li Liu, MD
Précis: Mammography may not offer survival advantage over annual breast examination
IntroductionThere is universal agreement that women 50 to 69 years of age should undergo screening mammography because randomized, controlled trials have shown that such screening reduces breast cancer mortality in this age group (JAMA 1995 Jan 11;273(2):149-54). This consensus is bolstered by the results of cost-effectiveness analyses that consistently show that this benefit can be achieved at a reasonable cost. However, when physical examination is performed in addition to mammogram, the extent to which mammogram contributes to the reduction of mortality in women is unknown. In this randomized study, the researchers compared breast cancer mortality following annual mammogram plus physical examination and physical examination only.
MethodA total of 39,405 women were assigned either to annual physical examination or to examination plus mammography since the mid-1980s.
DiscussionIn this study, adding mammography to careful annual physical examination had no impact on breast cancer mortality. Annual mammography plus physical examination did appear to have lead-time advantage with more patients detected in earlier stages. Unfortunately, these apparently favorable prognostic findings did not translate into a survival advantage for women screened with mammography plus physical examination. In addition to mammography and physical examination, breast self-examination may also play a positive role in reducing the mortality rate of breast cancer and should be studied in conjunction with mammography and physical examination.