We are pleased that our article on breast screening has created the interest and responses you have received. We of course agree with Dr Gardiner that participation rates over 90% would be optimal and have been achieved in a number of countries that are now reporting improvements in breast cancer survival.
The goal of 70% is a preliminary goal and unfortunately predicated on issues such as the availability of mammography technologists. Ultimately the SMPBC and any screening program benefits from greater participation. As well as screening, though, it is clear that improvements in the survival for women with breast cancer have also been affected by adjuvant systemic therapy and, more recently, evidence for radiation therapy.[1,2]
The recommendations of the SMPBC are based on evidence. At this time there is no clear evidence for the optimal frequency of mammography, but we are awaiting those results. Finally, the Breast Tumour Group does have guidelines for woman at high risk such as those with inherited genetic mutations that do combine mammography with MRI on an annual basis.
At this time, the most important message is that screening mammography is being underutilized and, as Dr Gardiner suggests, this must be improved.
—Karen A. Gelmon, MD FRCPC
—Barbara Poole, MPA
—Lisa Kan, MSc
1. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Clarke M, Coates AS, Darby SC, Davies C, Gelber RD et al. Adjuvant chemotherapy in oestrogen-receptor-poor breast cancer: Patient-level meta-analysis of randomised trials. Lancet. 2008;371:29-40.
2. Olivotto I, Bajdik CD, Plenderleith IH, Coppin C, Gelmon K, Jackson SM, Ragaz J, Noble M, Worth A. “Adjuvant systemic therapy and survival after breast cancer” NEJM 1994;330(12):805-810.
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