(This commentary was not written by CRD, but by the authors of the DH Register.)
1) The evidence for increased survival due to screening in this age group is contradictory. 2) The confidence interval for breast cancer death at 18 years, used in the baseline analysis, crosses zero. 3) Screening attendance is set at 25%. 4) Costs of false positive work-ups are included although QoL consequences of these are not. 5) Invitation costs are not included because women are already assumed to have an annual examination. 6) 18-year follow-up data from the HIP study were used as the baseline. However, HIP showed no benefit until 14 years, leaving the possibility that the gains were achieved by screening at age 50+. 7) Death from competing causes has not been discussed. 8) The sensitivity analysis was not adequate.