Possible net harms of breast cancer screening: updated modelling of Forrest report
Possible net harms of breast cancer screening: updated modelling of Forrest report
Objective: To assess the claim in a Cochrane review that mammographic breast cancer screening could be doing more harm than good by updating the analysis in the Forrest report, which led to screening in the United Kingdom.
Design: Development of a life table model, which replicated Forrest’s results before updating and extending them with data from relevant systematic reviews, trials, and other models based on purposive literature searches.
Participants: Women aged 50 and over invited for breast cancer screening.
Main outcome measures: Quality adjusted life years (QALYs), combining life years gained from screening with losses of quality of life from false positive diagnoses and surgery.
Results: Inclusion of the effects of harms reduced the updated estimate of net cumulative QALYs gained after 20 years from 3301 to 1536 or by more than half. The best estimates from the Cochrane review generated negative QALYs for the first seven years of screening, 70 QALYs after 10 years, and 834 QALYs after 20 years. Sensitivity analysis showed these results were robust to a range of assumptions, particularly up to 10 years. It also indicated the importance of the level and duration of harms from surgery.
Conclusions: This analysis supports the claim that the introduction of breast cancer screening might have caused net harm for up to 10 years after the start of screening.
d7627
Raftery, James
27c2661d-6c4f-448a-bf36-9a89ec72bd6b
Chorozoglou, Maria
1d8dc56f-914a-402a-8155-4fb1e4380835
8 December 2011
Raftery, James
27c2661d-6c4f-448a-bf36-9a89ec72bd6b
Chorozoglou, Maria
1d8dc56f-914a-402a-8155-4fb1e4380835
Raftery, James and Chorozoglou, Maria
(2011)
Possible net harms of breast cancer screening: updated modelling of Forrest report.
British Medical Journal, 343, .
(doi:10.1136/bmj.d7627).
(PMID:22155336)
Abstract
Objective: To assess the claim in a Cochrane review that mammographic breast cancer screening could be doing more harm than good by updating the analysis in the Forrest report, which led to screening in the United Kingdom.
Design: Development of a life table model, which replicated Forrest’s results before updating and extending them with data from relevant systematic reviews, trials, and other models based on purposive literature searches.
Participants: Women aged 50 and over invited for breast cancer screening.
Main outcome measures: Quality adjusted life years (QALYs), combining life years gained from screening with losses of quality of life from false positive diagnoses and surgery.
Results: Inclusion of the effects of harms reduced the updated estimate of net cumulative QALYs gained after 20 years from 3301 to 1536 or by more than half. The best estimates from the Cochrane review generated negative QALYs for the first seven years of screening, 70 QALYs after 10 years, and 834 QALYs after 20 years. Sensitivity analysis showed these results were robust to a range of assumptions, particularly up to 10 years. It also indicated the importance of the level and duration of harms from surgery.
Conclusions: This analysis supports the claim that the introduction of breast cancer screening might have caused net harm for up to 10 years after the start of screening.
This record has no associated files available for download.
More information
Published date: 8 December 2011
Organisations:
Primary Care & Population Sciences
Identifiers
Local EPrints ID: 338359
URI: http://eprints.soton.ac.uk/id/eprint/338359
ISSN: 0959-8138
PURE UUID: 7bc273e8-8921-4ad0-aeeb-321bd1f1e241
Catalogue record
Date deposited: 15 May 2012 08:29
Last modified: 15 Mar 2024 03:32
Export record
Altmetrics
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics
