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Possible net harms of breast cancer screening: updated modelling of Forrest report.

Abstract

OBJECTIVE

To assess the claim in a Cochrane review that mammographic breast cancer screening could be doing more harm than good by updating the analysis in the Forrest report, which led to screening in the United Kingdom.

DESIGN

Development of a life table model, which replicated Forrest's results before updating and extending them with data from relevant systematic reviews, trials, and other models based on purposive literature searches.

PARTICIPANTS

Women aged 50 and over invited for breast cancer screening.

MAIN OUTCOME MEASURES

Quality adjusted life years (QALYs), combining life years gained from screening with losses of quality of life from false positive diagnoses and surgery.

RESULTS

Inclusion of the effects of harms reduced the updated estimate of net cumulative QALYs gained after 20 years from 3301 to 1536 or by more than half. The best estimates from the Cochrane review generated negative QALYs for the first seven years of screening, 70 QALYs after 10 years, and 834 QALYs after 20 years. Sensitivity analysis showed these results were robust to a range of assumptions, particularly up to 10 years. It also indicated the importance of the level and duration of harms from surgery.

CONCLUSIONS

This analysis supports the claim that the introduction of breast cancer screening might have caused net harm for up to 10 years after the start of screening.

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  • Authors+Show Affiliations

    ,

    Faculty of Medicine, Wessex Institute, University of Southampton, Southampton SO16 7PX, UK. j.p.raftery@soton.ac.uk

    Source

    BMJ (Clinical research ed.) 343: 2011 Dec 08 pg d7627

    MeSH

    Breast Neoplasms
    Female
    Humans
    Mammography
    Mass Screening
    Middle Aged
    Quality of Life
    Quality-Adjusted Life Years
    Review Literature as Topic
    United Kingdom

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22155336

    Citation

    Raftery, James, and Maria Chorozoglou. "Possible Net Harms of Breast Cancer Screening: Updated Modelling of Forrest Report." BMJ (Clinical Research Ed.), vol. 343, 2011, pp. d7627.
    Raftery J, Chorozoglou M. Possible net harms of breast cancer screening: updated modelling of Forrest report. BMJ. 2011;343:d7627.
    Raftery, J., & Chorozoglou, M. (2011). Possible net harms of breast cancer screening: updated modelling of Forrest report. BMJ (Clinical Research Ed.), 343, pp. d7627. doi:10.1136/bmj.d7627.
    Raftery J, Chorozoglou M. Possible Net Harms of Breast Cancer Screening: Updated Modelling of Forrest Report. BMJ. 2011 Dec 8;343:d7627. PubMed PMID: 22155336.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Possible net harms of breast cancer screening: updated modelling of Forrest report. AU - Raftery,James, AU - Chorozoglou,Maria, Y1 - 2011/12/08/ PY - 2011/12/14/entrez PY - 2011/12/14/pubmed PY - 2012/1/21/medline SP - d7627 EP - d7627 JF - BMJ (Clinical research ed.) JO - BMJ VL - 343 N2 - OBJECTIVE: To assess the claim in a Cochrane review that mammographic breast cancer screening could be doing more harm than good by updating the analysis in the Forrest report, which led to screening in the United Kingdom. DESIGN: Development of a life table model, which replicated Forrest's results before updating and extending them with data from relevant systematic reviews, trials, and other models based on purposive literature searches. PARTICIPANTS: Women aged 50 and over invited for breast cancer screening. MAIN OUTCOME MEASURES: Quality adjusted life years (QALYs), combining life years gained from screening with losses of quality of life from false positive diagnoses and surgery. RESULTS: Inclusion of the effects of harms reduced the updated estimate of net cumulative QALYs gained after 20 years from 3301 to 1536 or by more than half. The best estimates from the Cochrane review generated negative QALYs for the first seven years of screening, 70 QALYs after 10 years, and 834 QALYs after 20 years. Sensitivity analysis showed these results were robust to a range of assumptions, particularly up to 10 years. It also indicated the importance of the level and duration of harms from surgery. CONCLUSIONS: This analysis supports the claim that the introduction of breast cancer screening might have caused net harm for up to 10 years after the start of screening. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/22155336/full_citation L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=22155336 DB - PRIME DP - Unbound Medicine ER -