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Open Access Opinion

Breast cancer screening: are we seeing the benefit?

Donella Puliti and Marco Zappa*

Author Affiliations

Clinical and Descriptive Epidemiology Unit, ISPO - Cancer Prevention and Research Institute, Via delle Oblate 2, 50141 Florence, Italy

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BMC Medicine 2012, 10:106  doi:10.1186/1741-7015-10-106

Published: 20 September 2012


A decline in breast cancer mortality has been observed in western European Countries since the middle of the 1990s.

Different methodological approaches, including case-control studies, incidence-based mortality studies, and trend studies, have been used to assess the effectiveness of mammography screening programmes in reducing breast cancer mortality. However, not all methods succeed in distinguishing the relative contributions of service screening and taking correctly into considerationthe potential source of bias that might affect the estimate.

Recently, a review of six case-control studies confirmed a breast cancer mortality reduction ranging from 38% to 70% among screened women. This figure is in accordance with the estimate obtained from incidence-based mortality studies if screening compliance is taken into account. We will describe the methodological constraints of mortality trend studies in predicting the impact of screening on mortality and the necessary caution that must be applied when interpreting the results of such studies.

In conclusion, when appropriate methodological approaches are used, it is evident that mammographic screening programmes have contributed substantially to the observed decline in breast cancer mortality.

Mammography screening; breast cancer mortality; case-control studies; incidence-based mortality studies; analysis of trends