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QUESTION: In women 40–49 years of age, does annual screening with mammography, clinical breast examination (CBE), and breast self examination (BSE) instruction reduce breast cancer mortality to a greater extent than a single CBE and BSE instruction?
Design
Randomised (allocation concealed*), blinded (outcome assessors),* controlled trial with mean 13 years of follow up.
Setting
15 centres in Canada.
Patients
50 489 women who were 40–49 years of age and had no previous diagnosis of breast cancer, were not pregnant, and had not had mammography in the previous 12 months. 50 430 (99.9%) were included in the analysis.
Intervention
All women received an initial CBE and instruction on BSE and were allocated to annual screening comprising mammography, CBE, and instruction and evaluation on BSE (n=25 214) or to usual care (n=25 216).
Main outcome measure
Breast cancer mortality.
Main results
Analysis was by intention to treat. During the first 5 years after study entry, the groups did not differ for breast cancer mortality rates and did not differ at each successive year of follow-up …
Footnotes
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For correspondence: Dr A B Miller, Deutsches Krebsforschungszentrum, Heidelberg, Germany. a.miller{at}dkfz-heidelberg.de
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Abstract and commentary also appear in ACP Journal Club.
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Sources of funding: 10 Canadian funding agencies.