A new study in the New England Journal of Medicine funded by Cancer Research UK and others (368;11 nejm.org march 14, 2013 987) ‘Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer’, Darby S C et al shows that exposure of the heart to ionizing radiation during radiotherapy for breast cancer (for either left or right breast) increases the subsequent rate of ischemic heart disease; the increase is proportional to the mean dose to the heart, begins a few years after exposure and continues for at least 20 years.
This surely illustrates that all cause mortality (not just deaths from breast cancer) DOES need to be taken into account when assessing risks of harm from breast screening, overdiagnosis and overtreatment.
Several letters in the Correspondence page in response to the Independent UK Panel on Breast Cancer Screening (Nov 17, p 1778) dispute the alleged beneficial effects of breast screening and rates of overdiagnosis in the Marmot Review (www.thelancet.com Vol 381 March 9, 2013 799). Peter C Gotzsche, Director of the Nordic Cochrane Research Centre, explains why all cause mortality should be included in outcomes for trials of breast screening and flags up many issues, including that many healthy overdiagnosed women will die from their breast cancer treatment (The Benefits and Harms of Breast Cancer Screening).
For the Nordic Cochrane Centre’s testimony, see: http://www.cochrane.dk