Paper of the Month - February, 2012

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Possible net harms of breast cancer screening: updated modelling of Forrest report.

Raftery J, M Chorozoglou.
The Forrest report, published in 1986, analyzed the costs and benefits of mammographic breast screening in terms of quality-adjusted life years (QALYs) and led to the introduction of mammographic screening in the UK (www.cancerscreening.nhs.uk/breastscreen/publications/forrest-report.html). One of the earliest uses of QALYs to guide policy, the report suggested that screening would reduce the breast cancer-related mortality rate by almost one-third with little harm and a low cost. The key data used in the Forrest report were drawn from two randomized trials: the Swedish two counties trial and the Health Insurance Plan New York trial. The Forrest report claimed that overdiagnosis was not a problem based on the New York trial, but noted that the Swedish trial found possible overdiagnosis in 20% of patients. The authors stated that “further follow-up is required to find out whether this excess persisted”.


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