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the Ontario Cancer Registry, 669 women treated for unilateral early-stage
breast cancer between 1994 and 1997 with a breast tumour recurrence more than
two years later (up to the end of December 2003) were studied by Paszat, Sutradhar, Gu, and Rakovitch (2016). The time interval between initial treatment and
the confirmation of an ipsilateral recurrence or contralateral primary was
compared between women who did and did not receive annual surveillance
mammography. It was concluded that an annual mammography screening following
treatment for early stage breast cancer moderately reduces breast cancer
mortality. Another case control study was conducted in the Netherlands from
1975 to 2012 by Ripping, van der Waal, Verbeek, and Broeders (2016) to examine the
effect of mammography screening on mortality rates from breast cancer in women
40 to 75 years of age with a high or low socioeconomic status (SES). Data
analyzed from the Netherlands’ national screening program suggests that mammographic
screening is equally effective at reducing mortality rates from breast cancer
in women regardless of SES. Since breast cancer is more prevalent in women with
a high SES, the latter suggests that a higher number of breast cancers can be prevented
with mammography screening for women with high SES.   

      The above research by Paszat et al. (2016)
and Ripping et al. (2016) comes from peer-reviewed journals with impact factors
of 2.048 and 2.133 respectively. These are moderate impact factor values
reflecting the frequency at which these papers have been cited. The studies
suggest that mammography screening moderately reduces mortality rates from
breast cancer; however, both studies failed to address the benefit-risk ratio
of undergoing mammography screening. Ripping et al. (2016) stated that women
with high SES have greater breast density, which can prevent tumour detection
on a mammogram. Therefore, research examining the risks of screening may reveal
that the risks outweigh the benefits for someone of a higher SES. This poses
the following question for future research to investigate; if the reduction in
mortality rates from breast cancer is only minor, can primary prevention (i.e. proper
diet and exercise) cause the same reduction in breast cancer mortality as
mammography screening? Additionally, are there other benefits to mammography
screening in addition to reduced mortality rates?

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et al. (2016) highlighted that only one other study had researched the effect
of mammography screening in younger women 40-49 years of age with a high or low
SES. Only women over 40 years of age were studied in both research papers
perhaps because they have the highest incidence of breast cancer. Future
research should address the influence that mammography screening has on women
younger than 40 years of age.

the long follow-up periods present in the two studies poses both advantages and
disadvantages to the research. As the screening programs progressed, radiological
screening equipment and techniques became more advanced. In addition to this, Ripping
et al. (2016) did not hold the number of mammograms constant across the whole
period and the Netherlands population data utilized by Paszat et al. (2016)
became more inclusive; however, due to the nature of the study, a long-follow
up period was necessary and enhanced the overall relevancy and quality as both
papers examined mortality rates.

The questions
and future research inquiries mentioned above need to be addressed prior to any
formal recommendations to patients as the benefit-risk ratio, age of diagnosis,
and limitations of the studies at hand are important contributing factors to whether
or not mammographic screening is appropriate.