ABSTRACT
Randomized trials of breast screening have now confi rmed the effi cacy of screening in women over 50 years of age where reductions of breast cancer mortality of between 25 and 30% are attainable (4-7). The World Health Organization in 2002 upheld these conclusions for screening mammography within this age group of women (8). There are clearly trans-Atlantic differences both in philosophy and practice in terms of breast cancer screening. Most of the key trials have been carried out in countries outside the United States and a majority of them are based on European populations. Interpretation of these trial data has varied among experts around the world and indeed within individual countries. Some of this controversy is related to the vagaries of statistical processing and manipulation while other aspects of contention are based on issues of cost-effectiveness and perceived value for money. For example, in 1993 the American Cancer Society and the European Society of Mastology met in New York and Paris respectively to review results of screening trials; they each arrived at opposite conclusions regarding screening of younger women between 40 and 49 years of age (9).
