1. Clare Foster Clare Foster Australia says:

    This lightweight analysis relates more to the lack of disclosure and hence understanding of breast screening effectiveness and risks. Women should be overtly, transparently and factually advised of the impacts of breastscreening including:

    •  the expected benefits (deaths reduced including disclosure that trial data is controversial, that mortality improvements more likely relate to treatment improvements occurring over the trial period, that two western countries have withdrawn screening programs based on independent reviews and that the global Cochrane Centre advises against screening)
    •  the risks/adverse consequences (over-diagnosis, unnecessary treatment, false positives, interval cancers…)
    •  the treatment consequences, complications and life time impacts (surgery, adjuvant therapy…) of, possibly, unnecessary treatment including reduced mortality in the case of
    radiation, chemotherapy and tamoxifen.

    It becomes a personal risk based decision whether it is worth the ~ 5:1 likely hood of over-diagnosis and high impact unnecessary treatment to reduce the possibility of dying from breast cancer by a small margin probably related to treatment improvement rather than screening. When presented with the full facts, the case of screening is not compelling and the consequences of ~50% (incl. DCIS) over-diagnosis hideous.

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