© 2005 Oxford University Press
EDITORIAL |
Effectiveness: The Next Question for Breast Cancer Screening
Correspondence to: Russell Harris, MD, MPH, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599-7590 (e-mail: rharris@med.unc.edu).
| The first 150 words of the full text of this article appear below. |
The discussion about breast cancer screening has changed. Yesterday's question was about efficacy—whether screening, under ideal circumstances, can reduce breast cancer mortality. Today's discussion is about a different question, effectiveness. To what extent is current screening, under usual conditions within the community, reducing mortality from breast cancer? The second question may prove to be as complex as the first.
The efficacy discussion largely concerned the internal validity of the eight randomized controlled trials (RCTs) of screening that were conducted between the mid-1960s and the mid-1980s. For the most part (there are still a few lingering issues), the question of efficacy is resolved. Careful observers, while acknowledging the presence of some bias in the RCTs, have concluded that the magnitude of these biases is not sufficient to invalidate the primary results of these trials, that periodic mammography, with or without clinical breast examination, reduces breast cancer mortality for women between 50
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