Overdiagnosis and overtreatment have practical though and psychologic implications. When one considers that the odds are changed very little by screening, there is plenty to ponder. The extent of overdiagnosis and overtreatment is significant. For the same group of 2000 women considered above, 6 extra women will have a lumpectomy, 4 extra women will have mastectomies, and 200 women will endure the anxiety of further invasive investigations that turn out to be negative. False negatives generate fear while results are awaited, with self-perceptions of being ��at high risk�� emerging unnecessarily. Angst about susceptibility is created in partners, mothers, sisters, and daughters who start to worry about a family history of breast cancer. A least 1 in 6 breast cancers detected by screening will be overdiagnosed and overtreated.

1�C3 The chance of recall in a woman aged 50 years who goes for mammography every 2 years until the age of 60 years is about 50:50. Screening mammography is not a no-brainer. It is a complex subject that is rightfully being scrutinized objectively. Before we pontificate on the topic, we would do well to guard against potential arrogance in the pursuit of preventative practice, which Sackett4 describes as having 3 elements: Aggressive assertiveness in prescribing what healthy people should do Confident presumptions that interventions will do more good than harm Overbearing assuredness and a lack of tolerance of those who challenge the principles Screening is not the same as preventative medicine, but the same rules apply.

Our patients have the right to be told the harms as well as the benefits of mammography and deserve our support when they have made up their minds. In the meanwhile, deaths from breast cancer in the United Kingdom continue to decrease. Rates in the last 20 years have fallen from above 40 per 100,000 to below 30 per 100,000 women and seem set to fall further. The reductions are across all age groups and are attributable to research leading to improved management and screening. Footnotes These summaries are reproduced from the Journal Article Summary Service, a monthly publication summarizing clinically relevant articles from the recent world literature. Please see http://www.jassonline.com or e-mail az.oc.bewm@tneklohta for more information.
Malaria is the second most common cause of infectious disease-related death in the world, after tuberculosis.

It is estimated to affect between 350 to 500 million people annually and accounts for 1 to 3 million Entinostat deaths per year.1,2 Sub-Saharan Africa has the largest burden of malarial disease, with over 90% of the world��s malaria-related deaths occurring in this region. Twenty-five million pregnant women are currently at risk for malaria, and, according to the World Health Organization (WHO), malaria accounts for over 10,000 maternal and 200,000 neonatal deaths per year.3 These figures may underestimate the impact malaria has in maternal morbidity and mortality.