Hennessey, LICSW Frances L. Hennessey, LICSW is a social worker, psychotherapist, and registered yoga teacher. She currently works with active duty military and their families. Small breast cancers confer a better prognosis than large ones. However, survival in the context of a screening programme is not predictive of reduced mortality because of lead time bias, length bias, or over diagnosis.1 Thus the benefit of mammography screening must be evaluated in randomised screening trials, with breast cancer mortality as the endpoint.Over diagnosis refers to the possibility that a screen detected cancer might not otherwise become clinically apparent during the lifetime of the woman.2 3 Over diagnosis can be estimated in a randomised screening trial when a sufficiently long period has elapsed from the cessation of screening that is, when all cancers should have become clinically apparent in both trial arms.In 1980 a randomised controlled trial of screening mammography and physical examination of breasts in 89835 women, aged 40 to 59, was initiated in Canada https://www.pandoracharm2013.ca/, the Canadian National Breast Screening Study.4 5 6 7 It was designed to tackle research questions that arose from a review of mammography screening in Canada8 and the report by the working group to review the US Breast Cancer Detection and Demonstration projects.9 At that time the only breast screening trial that had reported results was that conducted within the Health Insurance Plan of Greater New York.10 11 Benefit from combined mammography and breast physical examination screening was found in women aged 50 64, but not in women aged 40 49. Therefore the Canadian National Breast Screening Study was designed to evaluate the benefit of screening women aged 40 49 compared with usual care and the risk benefit of adding mammography to breast physical examination in women aged 50 59.
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