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To the Editor: In their study, Dr Joensuu and colleagues¹ reported that cancerous tumors detected by mammography screening have a lower risk of distant recurrence and better survival than those detected outside of screening, independent of the number of positive axillary lymph nodes, the primary tumor size, age at cancer detection, histological grade, and other biological factors.

In several European countries with nationwide screening programs, the breast cancer rate in the invited age groups is about 50% higher than the background level prior to the introduction of the screening program.^2-3 This difference has so far been explained by a lead-time effect, assuming that in the absence of screening such subclinical invasive disease (detectable by mammography screening) persists in the breast until symptoms develop at a later age. The cancer prevalence among women aged 65 to 69 years in the British⁴ and in the Dutch⁵ screening programs shows that this assumption . . . [Full Text of this Article]

Per-Henrik Zahl, MD, PhD
per-Henrik.Zahl@fhi.no
Norwegian Institute of Public Health
Oslo, Norway

Jannike Mørch Andersen, PhD; Jan Mæhlen, MD, PhD
Department of Pathology
Ullevål University Hospital
Oslo

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