Survival and reduction in mortality from breast cancer

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# Impact of mammographic screening is not clear {#article-title-2} EDITOR—We should all rejoice that there has been an improvement in survival and reduction in mortality for carcinoma of the breast, but Richards et al in their paper perpetuate the myth that this is related to the breast screening programme.1 The periods for comparison were 1981-5 and 1986-90. The Forrest report on mammographic screening was published in 1986,2 the first screening centres were established in 1988, and the country was not covered by the programme until 1990. Even the greatest zealots for mammographic screening would not expect an impact on mortality until 1997. The fall in mortality could therefore be attributed only to improvements in treatment, and it is relevant to note that the first overview of the trials of adjuvant systemic treatment were published in 1985.3 The only support for the assertion that the reduction in mortality can be attributed to the breast screening programme was a personal communication from S M Moss. Many people are of the opinion that mammographic screening is saving thousands of lives, but opinion alone does not provide sufficient data to support a publication in a prestigious journal such as the BMJ . 1. 1.↵1. Richards MA, 2. Stockton D, 3. Babb P, 4. Coleman MP . How many deaths have been avoided through improvements in cancer survival? BMJ 2000;320:895–898. (1 April.) [OpenUrl][1][Abstract/FREE Full Text][2] 2. 2.↵1. Forrest P . Breast cancer screening: Report to the Health Ministers of England, Wales, Scotland and Northern Ireland. London: HMSO, 1986. 3. 3.↵1. Early Breast Cancer Trialists Collaborative Group . Effects of adjuvant tamoxifen and of cytotoxics on mortality in early breast cancer: an overview of 61 randomised trials amongst 28,896 women. N Engl J Med 1988;319:1681–1692. [OpenUrl][3][PubMed][4][Web of Science][5] # Diagnostic practice in the United States is different {#article-title-5} EDITOR—Richards et al seem to have made inferences about “deaths avoided” using data on five year survival.1 This measure is, however, powerfully affected by diagnostic practice and is not a reliable indicator of mortality.2 In the United States the problem is best exemplified by prostate cancer. Five year survival has increased from about 40% in the 1950s to about 95% currently.3 Although it is tempting to conclude that we Americans have made major medical advances (and left the United Kingdom in the dust), the truth is that this largely reflects our diagnostic practice. As we aggressively seek and find early stage (and often innocuous) tumours, … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DRichards%26rft.auinit1%253DM%2BA%26rft.volume%253D320%26rft.issue%253D7239%26rft.spage%253D895%26rft.epage%253D898%26rft.atitle%253DHow%2Bmany%2Bdeaths%2Bhave%2Bbeen%2Bavoided%2Bthrough%2Bimprovements%2Bin%2Bcancer%2Bsurvival%253F%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.320.7239.895%26rft_id%253Dinfo%253Apmid%252F10741993%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=320/7239/895&atom=%2Fbmj%2F321%2F7274%2F1470.2.atom [3]: {openurl}?query=rft.jtitle%253DNew%2BEngland%2BJournal%2Bof%2BMedicine%26rft.stitle%253DNEJM%26rft.issn%253D0028-4793%26rft.volume%253D319%26rft.issue%253D26%26rft.spage%253D1681%26rft.epage%253D1692%26rft.atitle%253DEffects%2Bof%2Badjuvant%2Btamoxifen%2Band%2Bof%2Bcytotoxic%2Btherapy%2Bon%2Bmortality%2Bin%2Bearly%2Bbreast%2Bcancer.%2BAn%2Boverview%2Bof%2B61%2Brandomized%2Btrials%2Bamong%2B28%252C896%2Bwomen.%2BEarly%2BBreast%2BCancer%2BTrialists%2527%2BCollaborative%2BGroup%26rft_id%253Dinfo%253Apmid%252F3205265%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/external-ref?access_num=3205265&link_type=MED&atom=%2Fbmj%2F321%2F7274%2F1470.2.atom [5]: /lookup/external-ref?access_num=A1988R516200001&link_type=ISI

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