Whether breast cancer screening does more harm than good has been debated extensively. The main questions are how large the benefit of screening is in terms of reduced breast cancer mortality and how substantial the harm is in terms of over diagnosis, which is defined as cancers detected at screening that would not have otherwise become clinically apparent in the woman's lifetime. An independent Panel was convened to reach conclusions about the benefits and harms of breast screening on the basis of a review of published work and oral and written evidence presented by experts in the subject. To provide estimates of the level of benefits and harms, the Panel relied mainly on findings from randomised trials of breast cancer screening that compared women invited to screening with controls not invited, but also reviewed evidence from observational studies.
In view of the uncertainties in the published results of the randomised trials, the Panel supports the ongoing meta analysis of centrally collated individual patient data from all the randomised trials. The Panel also supports the use of randomized trials to investigate the balance of benefit to harm of breast cancer screening to women younger than 50 years and those older than 70 years. In view of the problems with estimation of the degree of over diagnosis from existing published work, the Panel encourages concerted attempts to provide more reliable and up-to-date estimates.
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