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Randomised controlled trial
Fifty years of age-based screening: time for a new risk-based screening approach
  1. Karla Kerlikowske1,
  2. Margaret E O'Kane2,
  3. Laura J Esserman1
  1. 1University of California, San Francisco, California, USA
  2. 2National Committee for Quality Assurance, Washington, DC, USA
  1. Correspondence to : Dr Karla Kerlikowske, General Internal Medicine Section, San Francisco Veterans Affairs Medical Center, 111A1, 4150 Clement Street, San Francisco, CA 94121, USA; karla.kerlikowske{at}

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The first screening mammography trial was conducted over 50 years ago; however, even today there is an ongoing debate over whether screening mammography averts breast cancer deaths. In the USA, the estimated cost of mammography screening in 2010 was $7.8 billion, endorsing strong acceptance that women should undergo screening mammography.1 The Canadian National Breast Screening Study (CNBS) results provide evidence to challenge whether routine, widespread annual screening mammography is indicated in large numbers of women.


CNBS-1 randomised women aged 40–49 years to undergo either annual mammography and clinical breast examination (CBE) or usual care. The CNBS-2 …

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  • Competing interests None.