AbstractObjective To compare breast cancer incidence and mortality up to 25 years in women aged 40 59 who did or did not undergo mammography screening.Design Follow up of randomised screening trial by centre coordinators, the study’s central office, and linkage to cancer registries and vital statistics databases.Setting 15 screening centres in six Canadian provinces,1980 85 (Nova Scotia, Quebec, Ontario, Manitoba, Alberta, and British Columbia).Participants 89835 women, aged 40 59, randomly assigned to mammography (five annual mammography screens) or control (no mammography).Interventions Women aged 40 49 in the mammography arm and all women aged 50 59 in both arms received annual physical breast examinations. Women aged 40 49 in the control arm received a single examination followed by usual care in the community.Main outcome measure Deaths from breast cancer.Results During the five year screening period, 666 invasive breast cancers were diagnosed in the mammography arm (n=44925 participants) and 524 in the controls (n=44910), and of these, 180 women in the mammography arm and 171 women in the control arm died of breast cancer during the 25 year follow up period. The overall hazard ratio for death from breast cancer diagnosed during the screening period associated with mammography was 1.05 (95% confidence interval 0.85 to 1.30).

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