Recently, we gave readers the opportunity to share their opinions on mammography screening in Clinical Decisions, an interactive feature in which experts discuss a controversial topic and readers vote and post comments. The feature coincided with the publication of an article by Bleyer and Welch(1), in which the long-term effects of mammography screening on the incidence of breast cancer in the United States between 1976 and 2008 were reported. The authors found a doubling of the incidence of early-stage breast cancers during this period but only a small decrease in the incidence of late-stage breast cancers during the same period. Moreover, the authors reported that in 2008, more than 30% of breast cancers that were detected were “overdiagnosed,” (i.e., were cancers that, if left untreated, never would have resulted in clinical symptoms).
To help us all better understand this contentious issue, we invited experts on breast-cancer screening to share their thoughts in three short essays. Smith, of the American Cancer Society, wrote an argument in favor of initiating mammography screening at the age of 40. Kerlikowske and Miglioretti shared a viewpoint in support of the recommendations of the U.S. Preventive Services Task Force (USPSTF), which suggest that women should be screened every other year starting at the age of 50. Finally, Kalager, a breast-cancer surgeon and epidemiologist from Norway, offered an argument against routine mammography screening, owing to the small absolute benefit and substantial risk of harm that can result from screening…
