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Screening reduces mastectomy rates

Are breast cancer screening programmes increasing rates of mastectomy? Observational study BMJ Volume 325 p 418

BMJ

The introduction of breast screening has brought about a reduction in mastectomy rates, despite recent suggestions that screening increases the number of mastectomies as a result of overdiagnosis, say researchers in this week's BMJ.

Between 1990 and 1996, over 59,000 women aged 50-69 years were invited to at least one breast screen as part of the Florence mammographic screening programme. Changes in rates of radical surgery and incidence of breast cancer since the introduction of the screening programme were analysed.

Rates of breast conserving surgery were 1.18 per thousand in 1990 and 1.87 per thousand in 1996. In 1990, the rate of mastectomy was 1.08 per thousand, whereas in 1996 it was 0.62 per thousand.

The rate of breast conserving surgery has increased significantly with the advent of screening, and the rate of radical surgery has declined significantly, say the authors. Similar reductions in mastectomy rates have been observed elsewhere.

This indicates that the introduction of screening brings about a reduction in mastectomy rates, not an increase, they add. Follow up will continue to ascertain whether these findings are maintained.

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