Breast Cancer Screening and Diagnosis
Authors: Zuleika Saz-Parkinson, Stephen W. Duffy, Carlos Canelo-Aybar, Axel Gräwingholt, Cecily Quinn, Markus Follmann, Holger J. Schünemann
Journal: Annals of Internal Medicine (2020)

Letters16 June 2020Breast Cancer Screening and DiagnosisZuleika Saz-Parkinson, PhD, Stephen W. Duffy, BSc, MSc, Carlos Canelo-Aybar, MD, MSc, Axel Gräwingholt, MD, Cecily Quinn, MD, Markus Follmann, MD, MPH, MSc, and Holger J. Schünemann, MD, PhD, MScZuleika Saz-Parkinson, PhDEuropean Commission, Joint Research Centre, Ispra, Italy (Z.S.)Search for more papers by this author, Stephen W. Duffy, BSc, MScQueen Mary University of London, London, United Kingdom (S.W.D.)Search for more papers by this author, Carlos Canelo-Aybar, MD, MScIberoamerican Cochrane Centre, Barcelona, Spain (C.C.)Search for more papers by this author, Axel Gräwingholt, MDRadiologie am Theater, Paderborn, Germany (A.G.)Search for more papers by this author, Cecily Quinn, MDSt. Vincent's University Hospital, Dublin, Ireland (C.Q.)Search for more papers by this author, Markus Follmann, MD, MPH, MScGerman Cancer Society, Berlin, Germany (M.F.)Search for more papers by this author, and Holger J. Schünemann, MD, PhD, MScMcMaster University, Hamilton, Ontario, Canada (H.J.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-0254 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:The ECIBC's strong recommendation for screening in women aged 50 to 69 years was not a result of high-certainty evidence for breast cancer mortality as suggested by Dr. Jörgensen and Mr. Paludan-Müller. The strong (rather than conditional) recommendation, in the context of organized screening programs, was instead a result of a balance of health effects that favor the intervention—with moderate (not high) overall certainty in the evidence about these effects—and cost-effectiveness that probably favors screening.Dr. Jörgensen and Mr. Paludan-Müller incorrectly cite a GRADE article about prognosis (reference 5 in their comment) when raising an issue about effects ...References1. Guyatt GH, Oxman AD, Vist G, et al. GRADE guidelines: 4. Rating the quality of evidence—study limitations (risk of bias). J Clin Epidemiol. 2011;64:407-415. [PMID: 21247734] doi:10.1016/j.jclinepi.2010.07.017 CrossrefMedlineGoogle Scholar2. Independent UK Panel on Breast Cancer Screening. The benefits and harms of breast cancer screening: an independent review. Lancet. 2012;380:1778-1786. [PMID: 23117178] doi:10.1016/S0140-6736(12)61611-0 CrossrefMedlineGoogle Scholar3. Gøtzsche PC, Jørgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2013:CD001877. [PMID: 23737396] doi:10.1002/14651858.CD001877.pub5 CrossrefMedlineGoogle Scholar4. Heywang-Köbrunner SH, Schreer I, Hacker A, et al. Conclusions for mammography screening after 25-year follow-up of the Canadian National Breast Cancer Screening Study (CNBSS). Eur Radiol. 2016;26:342-350. [PMID: 26017741] doi:10.1007/s00330-015-3849-2 CrossrefMedlineGoogle Scholar5. Saadatmand S, Bretveld R, Siesling S, et al. Influence of tumour stage at breast cancer detection on survival in modern times: population based study in 173,797 patients. BMJ. 2015;351:h4901. [PMID: 26442924] doi:10.1136/bmj.h4901 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: European Commission, Joint Research Centre, Ispra, Italy (Z.S.)Queen Mary University of London, London, United Kingdom (S.W.D.)Iberoamerican Cochrane Centre, Barcelona, Spain (C.C.)Radiologie am Theater, Paderborn, Germany (A.G.)St. Vincent's University Hospital, Dublin, Ireland (C.Q.)German Cancer Society, Berlin, Germany (M.F.)McMaster University, Hamilton, Ontario, Canada (H.J.S.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2125. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBreast Cancer Screening and Diagnosis: A Synopsis of the European Breast Guidelines Holger J. Schünemann , Donata Lerda , Cecily Quinn , Markus Follmann , Pablo Alonso-Coello , Paolo Giorgi Rossi , Annette Lebeau , Lennarth Nyström , Mireille Broeders , Lydia Ioannidou-Mouzaka , Stephen W. Duffy , Bettina Borisch , Patricia Fitzpatrick , Solveig Hofvind , Xavier Castells , Livia Giordano , Carlos Canelo-Aybar , Sue Warman , Robert Mansel , Francesco Sardanelli , Elena Parmelli , Axel Gräwingholt , Zuleika Saz-Parkinson , and Breast Cancer Screening and Diagnosis Karsten J. Jørgensen and Asger S. Paludan-Müller Breast Cancer Screening and Diagnosis Hans-Olov Adami and Philippe Autier Metrics 16 June 2020Volume 172, Issue 12Page: 840-841KeywordsBreast cancerBreast cancer screeningConflicts of interestDisclosureGrading of Recommendations Assessment Development and EvaluationLesionsMammographyMortalityRandomized trialsResearch reporting guidelines ePublished: 16 June 2020 Issue Published: 16 June 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...