Study objective-To determine whether mortality from breast cancer could be reduced by repeated mammographic screening.Design-Birth year cohorts of city population separately randomised into study and control groups.Setting-Screening clinic outside main hospital. Patients-Women aged over 45; 21088 invited for screening and 21 195 in control group.Interventions-Women in the study group were invited to attend for mammographic screening at intervals of 18-24 months. Five rounds of screening were completed. Breast cancer was treated according to stage at diagnosis.End point-Mortality from breast cancer. Measurements and main results-All women were followed up and classed at end point as alive without breast cancer, alive with breast cancer, dead from breast cancer, or dead from other causes. Cause of death was taken from national mortality registry and for patients with breast cancer was validated independently. Mean follow up was 8-8 years. Altogether 588 cases of breast cancer were diagnosed in the study group and 447 in the control group; 99 v 94 women died of all causes and 63 v 66 women died of breast cancer (no significant difference; relative risk 0-96 (95% confidence interval 0*68 to 1.35)). In the study group 29% more women aged <55 died of breast cancer (28 v 22; relative risk 1.29 (0.74 to 2.25)). More women in the study group died from breast cancer in the first seven years; after that the trend reversed, especially in women aged -55 at entry. Overall, women in the study group aged -55 had a 20% reduction in mortality from breast cancer (35 v 44; relative risk 0 79 (0.51 to 1.24)).Other findings-In the study group 100 (17%) cancers appeared in intervals between screenings and 107 (18%) in non-attenders; 51 of these women died from breast cancer. Cancers classed as stages II-IV comprised 33% (190/579) of cancers in the study group and 52% (231/443) in the control group.Conclusions -Invitation to mammographic screening may lead to reduced mortalify from breast cancer, at least in women aged 55 or over.

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In order to find some guidelines for adequate examination of the often very large amount of tissue removed at reduction mammoplasties, a thorough macro- and microscopic study of a total of 400 specimens from 200 consecutive cases of bilateral breast reductions was done. The majority of patients were younger than 30 years of age. In these cases no abnormalities were found and a thorough macroscopic examination performed by an experienced pathologist is believed to be sufficient in this age group. In older women we encountered diverse findings, the most noteworthy being lobular carcinoma in situ in 8% of patients in this series who were over 40 years of age. This indicates the need for generous histological sampling in this age group. The potential value of roentgenological examination is also discussed.