1.Main question/aim: The aim of the study was to determine whether annual mammograms reduces the mortality rate of women aged between 40 to 59 diagnosed with breast cancer, by comparing women who had...

1.Main question/aim:
The aim of the study was to determine whether annual mammograms reduces the mortality rate of  women aged between 40 to 59 diagnosed with breast cancer, by comparing women who had mammograms with those who did not.
2. Did the authors choose an appropriate study design to answer the research question? (if not what methods would you suggest &why)    The study design is well thought out and appropriate for this type of research. Not only did they recruit a very large number of women (89,835) for this trial, making the statistical analysis very tight, they were careful to ensure completely randomised trial so there would be no bias in the data. Also the study was performed over a 25 year period.
3.Main Finding
The main finding was that performing annual mammograms in women between the ages of 40 – 59 does not improve the mortality rate of women diagnosed with breast cancer in comparison with women who have been diagnosed by physical examination only. The study also found that annual mammograms led to over diagnosis of breast cancer, finding that 22% of the women who had mammograms had over diagnosed cancers.
4.Main weaknesses/limitations
The main weakness of this study is that the findings may not be applicable to all countries, as this study was performed in Canada where education and technology are more advanced. In countries with lower education and technology, the findings are that breast cancers are detected too late usually resulting in a higher mortality rate. This study showed early detection is imperative to survival rate.
5. What findings we think should be acted upon, by what health professionals, with who and how.    The finding that breast cancers are diagnosed by physical examination at the same rate as diagnosis with mammograms, suggests that people need to be educated about the need for regular physical examination, by a physician and by the women herself. Mammograms are useful as a tool but not essential for breast diagnosis if the patients are vigilant with regular physical examination. Mammograms also lead to over diagnosis of breast cancer which is a problem which needs to be addressed, as over diagnosis can lead to unnecessary stress in patients.
6.Real-world factors (political/social/cultural/environmental) I/we think could stop the findings of this research from being acted on in real-world health policy or practice    As the authors suggest the situation in poor countries is very different and the rate of mortality from breast cancer is higher because diagnosis is often too late. The lack of education and access to doctors means that physical examination is not happening on a regular basis and a tool such as a mammogram may be useful for earlier detection in these countries.
7. Do I/we think the finding(s) reported in this article, if misconstrued or reported in the media irresponsibly, could possibly have a detrimental impact on clinical practice, health outcomes, or any social group? How, or why not?

If these findings were misconstrued in the media, biasing mammograms, leading to an increase in the rate of women having mammograms performed, there may be an increase in over diagnosis of breast cancer, due to the nature of this test. However, if the medias report lead to a decreased use of mammograms, this studies finding showed that as long as there is education concerning physical examination, rate of breast cancer being diagnosed should not be effected.