Mammographic screening: no reliable supporting evidence?

Much confusion is being generated by the conclusion of a recent review that "there is no reliable evidence that screening for breast cancer reduces mortality." In that review, however, there was no appreciation of the appropriate mortality-related measure of screening's usefulness; and correspondingly, there was no estimation of the magnitude of this measure. We take this measure to be the proportional reduction in case-fatality rate, and studied its magnitude on the basis of the only valid and otherwise suitable trial. We found reliable evidence of fatality reduction, apparently substantial in magnitude.