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Special Communication |

Quantifying the Benefits and Harms of Screening Mammography

H. Gilbert Welch, MD, MPH1; Honor J. Passow, PhD1
[+] Author Affiliations
1The Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
JAMA Intern Med. 2014;174(3):448-454. doi:10.1001/jamainternmed.2013.13635.
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Like all early detection strategies, screening mammography involves trade-offs. If women are to truly participate in the decision of whether or not to be screened, they need some quantification of its benefits and harms. Providing such information is a challenging task, however, given the uncertainty—and underlying professional disagreement—about the data. In this article, we attempt to bound this uncertainty by providing a range of estimates—optimistic and pessimistic—on the absolute frequency of 3 outcomes important to the mammography decision: breast cancer deaths avoided, false alarms, and overdiagnosis. Among 1000 US women aged 50 years who are screened annually for a decade, 0.3 to 3.2 will avoid a breast cancer death, 490 to 670 will have at least 1 false alarm, and 3 to 14 will be overdiagnosed and treated needlessly. We hope that these ranges help women to make a decision: either to feel comfortable about their decision to pursue screening or to feel equally comfortable about their decision not to pursue screening. For the remainder, we hope it helps start a conversation about where additional precision is most needed.

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Figure.
Benefit-Harm Trade-off for a 10-Year Course of Annual Screening Mammography for Women Starting at Age 40, 50, and 60 Years

Reducing the frequency from annual to every 2 years has been demonstrated to substantially reduce the harm of false alarms and would be expected to reduce the harm of overdiagnosis. The Figure is available as “Table 5” in Supplement 1.

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