Breast cancer screening expansion: modelling doesn’t reflect real life and should not be used to update guidance

The move by the US Preventive Services Task Force to recommending screening mammography for women aged 40-49 is all the more remarkable as large randomised trials in the UK failed to show a reduction in the risk of breast cancer death in women aged 39-41 years at first invitation to screening.12 In addition, screening mammography has a limited ability to detect the ER negative and grade 3 tumours that are more frequent among black than among white US women.3The US Preventive Services Task Force has invested in statistical model approaches. But models do not inform about the effectiveness of a screening programme: they just provide a simulated effectiveness. The simulation consists of substituting parameters of a gold standard screening setting where the risk of breast cancer death is reduced thanks to screening with parameters of an alternative screening setting under consideration. Parameters of a gold standard screening setting include age…
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