It Is Time to Initiate Another Breast Cancer Screening Trial

Jüni, Peter; Zwahlen, Marcel

doi:10.7326/m14-0569

Cited by 11 publications

(22 citation statements)

References 6 publications

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“…In diesen sechs Studien zeigt sich keine Reduktion der Gesamt sterblichkeit, obwohl die beobachtete Senkung der Brustkrebsmortalität die Gesamtsterblichkeit um rund 2 % senken müsste. Das kombinierte relative Risiko betrug 1,00, mit einem engen Ver trauens intervall von 0,97 bis 1,02 [ 6]. Anders a us gedrückt: Die diskrete Reduktion der Brustkrebs mortalität (Abb.…”

Section: Replik Zum Vorangegangenenunclassified

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Replik zum vorangegangenen Beitrag «Swiss Medical Board – cui bono?»

2014

Schweiz Ärzteztg

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Section: Replik Zum Vorangegangenenunclassified

“…Die Meta-Analyse hätte gute Argumente für die Annahme geliefert, dass durch Mammographie gar kein Leben gerettet wird [6].…”

Section: Replik Zum Vorangegangenenunclassified

Replik zum vorangegangenen Beitrag «Swiss Medical Board – cui bono?»

2014

Schweiz Ärzteztg

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“…A claimed screening benefit on non-bca deaths would tend to suggest baseline imbalances (selection bias), random occurrence, or performance bias (differences in care favouring the screening group 28 ). Alternatively, a significant increase in non-bca deaths suggests either baseline imbalances favouring the control group or detection bias from differential misclassification of deaths (screening group favoured for bca deaths, control group for non-bca deaths 28,29 …”

Section: Trial Consistencymentioning

confidence: 99%

“…Recently Peter Jüni and Marcel Zwahlen analyzed mammography trials 28 as to trial consistency with respect to the reduction in bca versus non-bca deaths, using that index as a marker of proper trial design, because mammography cannot be expected to incidentally detect treatable non-breast causes, only to reduce bca deaths. A claimed screening benefit on non-bca deaths would tend to suggest baseline imbalances (selection bias), random occurrence, or performance bias (differences in care favouring the screening group 28 ).…”

Section: Trial Consistencymentioning

confidence: 99%

Beyond the Mammography Debate: A Moderate Perspective

Kaniklidis¹

2015

Current Oncology

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After some decades of contention, one can almost despair and conclude that (paraphrasing) "the mammography debate you will have with you always." Against that sentiment, in this review I argue, after reflecting on some of the major themes of this long-standing debate, that we must begin to move beyond the narrow borders of claim and counterclaim to seek consensus on what the balance of methodologically sound and critically appraised evidence demonstrates, and also to find overlooked underlying convergences; after acknowledging the reality of some residual and non-trivial harms from mammography, to promote effective strategies for harm mitigation; and to encourage deployment of new screening modalities that will render many of the issues and concerns in the debate obsolete.To these ends, I provide a sketch of what this looking forward and beyond the current debate might look like, leveraging advantages from abbreviated breast magnetic resonance imaging technologies (such as the ultrafast and twist protocols) and from digital breast tomosynthesis-also known as three-dimensional mammography. I also locate the debate within the broader context of mammography in the real world as it plays out not for the disputants, but for the stakeholders themselves: the screening-eligible patients and the physicians in the front lines who are charged with enabling both the acts of screening and the facts of screening at their maximally objective and patientaccessible levels to facilitate informed decisions. Key Words REFLECTIONS ON SOME CENTRAL THEMESAll screening programmes do harm; some do good as well, and, of these, some do more good than harm at reasonable cost.-Sir Muir Grey, former director of the U.K. National Screening Committee 1 Some Issues Deserving More AttentionSeveral core issues require closer examination:1. The potential benefits of mammographic screening independent of whether ultimate survival is affected, including diagnosis at earlier stages, typically with smaller tumours and node negativity; reduced likelihood of aggressive treatments and morbidities; detection of high-risk lesions (most diagnosed in the screened group 2 ) allowing for chemoprevention or magnetic resonance imaging (mri) surveillance against occult malignancies, or both; and avoidance of compromised quality of life after diagnosis of advanced disease It is not clear, as often assumed, that survival is the best (or only) measure for judging mammographic screening 2,3 . And it remains open whether claimed harms truly are disproportionate to benefits when using, for instance, a more nuanced definition of overdetection than simply breast cancer (bca) diagnosed but not bca expired (distinguishing, for example, longer recurrence-free survival from simple overall survival benefit).

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“…L'analyse de la littérature ancienne n'amène à se poser qu'une question : faut-il un nouvel essai contrôlé ? [4]. La seconde conclusion, « Une femme qui refuse le dépistage du cancer du sein est beaucoup moins déraisonnable qu'une femme qui continue à fumer car le tabac tue un consommateur régulier sur deux », pose une autre question qui peut être rédigée autrement.…”

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Correspondance à propos de l’article « Dépistage du cancer du sein ». Des conclusions… aux actes !

Braillon

2014

La Presse Médicale

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It Is Time to Initiate Another Breast Cancer Screening Trial

Cited by 11 publications

References 6 publications

Replik zum vorangegangenen Beitrag «Swiss Medical Board – cui bono?»

Replik zum vorangegangenen Beitrag «Swiss Medical Board – cui bono?»

Beyond the Mammography Debate: A Moderate Perspective

Correspondance à propos de l’article « Dépistage du cancer du sein ». Des conclusions… aux actes !

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