Breast screening policy: are we heading in the right direction?

Abstract

There is a large body of evidence supporting 2-yearly screening of women aged 50-69 years. There is good evidence for a mortality reduction from mammographic screening in women aged 40 to 49 years but a 1-year interval is required. The lack of specificity of screening in young women does remain a problem. There is no evidence to suggest that a single screen between the ages of 47 and 50 years within a programme screening at 3-year intervals will reduce mortality; the trials showing a mortality benefit in women in their 40s included multiple screening episodes and shorter screening intervals. There is no randomized, controlled trial evidence to support screening in women aged above 70 years and screening this age group will cause greater harm than in younger women through higher rates of over-diagnosis and consequent over-treatment. The randomized phase of the screening age extension, which at the moment is planned to last only 6 years, should not be immediately followed by general implementation of the policy. Only if and when additional mortality reductions and an acceptable balance between benefit and harms are shown to be achieved by the extra screens should the 2007 Cancer Reform Strategy policy on age extension be implemented. Resources saved by delaying or abandoning the roll-out of the age extension could potentially be redirected towards reducing the current 3 year screening interval to 2 years in women aged 50-69 years. However, reducing the screening interval to 2 years for women aged 50-69 years would require significantly more screening invitations and resources than the proposed age extension.