OBJECTIVE: The objective of this commentary is to argue that advances in therapy are diminishing the efficacy of mammography screening. METHOD: Key studies which demonstrate this effect are briefly reviewed. RESULTS: The author argues that, for screening to be beneficial, the treatment of screen-detected cancers must be more effective than that of clinically-detected cancers. If there was no effective therapy for breast cancer, then screening would offer no benefit. Furthermore, as breast cancer treatments improve over time, both the absolute and relative benefits of screening will diminish. This is evident in the overview of the nine successive mammography screening trials, which have shown a decrease in the benefit of mammography screening over time, with the three most recent trials showing no benefit at all. Breast cancer adjuvant therapy was widely available in the three most recent mammography screening trials, but not the earlier trials. Additionally, population-based studies seem to suggest that the benefit of mammography screening is diminishing as treatments continue to improve. CONCLUSION: Thus, in the years ahead, further declines in breast cancer mortality will likely be fueled by advances in therapy, and not by improvements in screening technology.
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