Your attempt to debunk the “myth” that cancer screening saves lives is ill-conceived for breast cancer (Nature 528, 322–325; 2015). Women should be aware of the benefits and potential harms of breast screening, including that it can reduce the chance of death from breast cancer.
You cite one randomized screening trial that showed no reduction in deaths due to breast cancer. However, an independent meta-analysis of 11 trials, including the one you cite, demonstrates an overall 20% reduction in mortality (M. G. Marmot et al. Lancet 380, 1778–1786; 2012).
Further analysis reveals that only those trials that reduced the incidence of advanced disease (stage II or higher) produced lower mortality (L. Tabár et al. Breast J. 21, 13–20; 2015). This correlation supports the idea that reducing the incidence of advanced breast cancer by using other screening methods might reasonably be expected to reduce mortality. For example, combining mammography with magnetic resonance imaging reduces the chance that women who have a high breast-cancer risk will be diagnosed with late-stage disease (E. Warner et al. J. Clin. Oncol. 19, 3524–3531; 2001).
Screening is also beneficial because early detection reduces the need for mastectomy and chemotherapy. As treatments become more effective, the mortality benefit from screening might be anticipated to decline, but the other benefits will remain.
Wendie A. Berg, MD, PhD, FACR is a practising breast imaging radiologist.
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Berg, J., Berg, W. No myth: Benefits of breast screening. Nature 529, 283 (2016). https://doi.org/10.1038/529283b