Drs. Gordon and Kopans,

The NEJM rehash was fair comment on a study with sufficient inconsistencies to question the findings.  

The Pan-Canadian study despite the large number of participants had troublingly wide confidence intervals.   In addition the numbers needed to participate (NNP) in screening to prevent one death was 1247 age 49-50, 757 age 50 to 60, 552 age 60 to 70 and 490 age 70-79 would seem high when relating benefit to risk.

The Cochrane study cited in the article has its own problems but nevertheless presents a view that is worth reading.

The first consideration when contemplating mammography, or any other investigation or intervention, is that the physician should have a duty of care to disclose the actual benefit and the actual risk so the patient can make an informed decision.