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Comment & Response
April 5, 2016

Breast Cancer Screening: Benefit or Harm?—Reply

Author Affiliations
  • 1Duke Evidence Synthesis Group, Durham, North Carolina
JAMA. 2016;315(13):1402-1403. doi:10.1001/jama.2015.19129

In Reply In the Cochrane meta-analysis limited to “adequately randomized” trials, the pooled estimate for mortality reduction was 0.90 (95% CI, 0.79-1.02).1 We included the results of this more restrictive analysis in presentations of our results to the ACS Guidelines Development Group. Although we agree that variation in study design or conduct may result in some bias in estimate within the randomized trials, we share the judgment of the UK Independent Panel that these are unlikely to substantially affect the estimate, given the general consistency of results,2 and elected to present the results of meta-analyses that included the same trials primarily for space considerations. We certainly did not intend to imply that there is scientific agreement about the extent by which (or even if) mammography reduces breast cancer mortality. Although some policy makers are using these more restrictive estimates,3 other groups have put a stronger emphasis on more recent observational studies with a far greater mortality reduction.4

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