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Breast examination was carried out by nurses unless stated otherwise ( ve indicates abnormality found by examiner, -ve no abnormality found).

MA=mammography ( ve indicates abnormality found by radiologist, -ve no abnormality found).

After 15 years of follow-up a residual excess of 106 cancers was observed in the mammography arm, attributable to over-diagnosis.

Conclusion Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available.

Mammogram detected non-palpable breast cancers are smaller on average than clinically palpable breast cancers.

Over-diagnosis refers to the possibility that a screen detected cancer might not otherwise become clinically apparent during the lifetime of the woman.2 3 Over-diagnosis can be estimated in a randomised screening trial when a sufficiently long period has elapsed from the cessation of screening—that is, when all cancers should have become clinically apparent in both trial arms.

Randomisation was individual and stratified by centre and five year age group.5 Irrespective of the findings on physical examination, women aged 40-49 were independently and blindly assigned randomly to receive mammography or no mammography.

Those allocated to mammography were offered another four rounds of annual mammography and physical examination, those allocated to no mammography were told to remain under the care of their family doctor, thus receiving usual care in the community, although they were asked to complete four annual follow-up questionnaires.

All screening centres were located in teaching hospitals or in cancer centres.

The central coordinating centre was at the University of Toronto.

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