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13-Year Results of Canadian Breast Cancer Screening Trial

Although mammography screening for breast cancer among women 50 years of age and older has been shown in several studies to reduce breast cancer deaths compared with no screening, the incremental effect of mammography screening over and above physical examination of the breasts is not known. Miller et al. (p. 1490), in a breast screening study in Canada, compared 39,405 women randomly assigned to receive either annual mammographic screening plus physical examination of the breasts or annual physical examination alone. All women were taught breast self-examination one-to-one by trained personnel. More breast cancers were detected in the group receiving mammography, but breast cancer deaths were equal in the two groups. These findings, after an average follow-up of 13 years, confirm early results from the same trial. The authors suggest that physical breast examination, combined with competent breast self-examination, may be an alternative to mammographic screening in women aged 50 years and older.