Mammography in the 1990s: a plea for objective doctors and informed patients.

Mammography screening is increasingly promoted as a means to avoid death from breast cancer. Although some randomized trials have shown a mortality benefit in the older screened groups, not all the results have been statistically significant; benefit has not been shown in younger age groups. Mammography detects smaller lesions than physical examination, but the only randomized trial comparing the mortality benefits of mammography and physical examination shows no benefit for mammography. The systemic nature of breast cancer raises questions about the theoretical mortality benefit of screening. Patients undergoing mammography may experience unexpected anxiety about the results. Candidates for screening should be routinely informed of these issues.