Effect of mammographic screening from age 40 years on breast cancer mortality in the UK Age trial at 17 years' follow-up: a randomised controlled trial

Moss, Sue; Wale, Chris; Smith, Robert A.; Evans, Andrew; Cuckle, Howard; Duffy, Stephen W.

doi:10.1016/s1470-2045(15)00128-x

Cited by 180 publications

(131 citation statements)

References 29 publications

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“…They are also consistent with those of a major cohort evaluation of screening in this age group 12. The UK Age Trial found a smaller effect of screening in this age group that was partly due to lower participation rates and partly due to the fact that the screening in the UK Age Trial had only a transient effect on mortality from aggressive, grade 3 breast cancers 11. In the current study, on the other hand, there was a substantial effect on deaths due to grade 3 breast cancers in women younger than 50 years.…”

Section: Discussionsupporting

confidence: 85%

Updated results of the Gothenburg Trial of Mammographic Screening

Bjurstam

Björneld

Duffy

2016

Cancer

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BACKGROUNDThere remain uncertainties about age‐specific effects of breast cancer screening on mortality due to the disease.METHODSIn 1982, a randomized trial of mammographic screening every 18 months was started in Gothenburg, Sweden. Women between the ages of 39 and 49 years were randomized to an invitation to screening (intervention group; n = 11,792) or to usual care (the control group; n = 14,321). The corresponding numbers for women between the ages of 50 and 59 years were 10,112 and 15,997. Follow‐up data for breast cancer mortality were available up to the end of 2007. Data were analyzed by Poisson regression with conservative variance estimates.RESULTSThere were 79 breast cancer deaths in the intervention arm and 156 in the control arm, and this meant a significant 30% reduction in breast cancer mortality with the offer of screening (relative risk [RR], 0.70; 95% confidence interval [CI], 0.53‐0.93; P = .01). In women aged 39 to 49 years, there was a significant 40% reduction in breast cancer mortality (RR, 0.60; 95% CI, 0.43‐0.85; P = .003). In the 50‐ to 59‐year age group, there was a nonsignificant 18% breast cancer mortality reduction (RR, 0.82; 95% CI, 0.54‐1.26; P = .4).CONCLUSIONSThe policy of offering mammographic screening substantially reduces breast cancer mortality and can do so in women younger than 50 years. Cancer 2016;122:1832–5. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

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Section: Discussionsupporting

confidence: 85%

Updated results of the Gothenburg Trial of Mammographic Screening

Bjurstam

Björneld

Duffy

2016

Cancer

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“…The authors also found no evidence for increased overdiagnosis in that age group. 33 For older women, the decision to screen is more complicated. ACS guidelines recommend annual screening only if older women have life expectancy of at least 5 years and only if they are in generally good health, with no significant comorbid conditions; thus, there are no data to indicate whether, or at what frequency, screening in older women is or is not supported by ACS guidelines.…”

Section: Overdiagnosis and Agementioning

confidence: 99%

Implications of Overdiagnosis: Impact on Screening Mammography Practices

Morris

Feig

Drexler

et al. 2015

Population Health Management

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This review article explores the issue of overdiagnosis in screening mammography. Overdiagnosis is the screen detection of a breast cancer, histologically confirmed, that might not otherwise become clinically apparent during the lifetime of the patient. While screening mammography is an imperfect tool, it remains the best tool we have to diagnose breast cancer early, before a patient is symptomatic and at a time when chances of survival and options for treatment are most favorable. In 2015, an estimated 231,840 new cases of breast cancer (excluding ductal carcinoma in situ) will be diagnosed in the United States, and some 40,290 women will die. Despite these data, screening mammography for women ages 40-69 has contributed to a substantial reduction in breast cancer mortality, and organized screening programs have led to a shift from late-stage diagnosis to early-stage detection. Current estimates of overdiagnosis in screening mammography vary widely, from 0% to upwards of 30% of diagnosed cancers. This range reflects the fact that measuring overdiagnosis is not a straightforward calculation, but usually one based on different sets of assumptions and often biased by methodological flaws. The recent development of tomosynthesis, which creates high-resolution, three-dimensional images, has increased breast cancer detection while reducing false recalls. Because the greatest harm of overdiagnosis is overtreatment, the key goal should not be less diagnosis but better treatment decision tools. (Population Health Management 2015;18:S3-S11)

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“…Breast cancer (currently considered a heterogeneous disease) mortality decreased significantly over the past three decades worldwide [25][26][27][28] due to early detection [29][30][31][32] and adjuvant systemic therapy (AST) [32,33]. However the risk of recurrence is still high and dependent upon numerous factors including tumor size, involvement of regional lymph nodes, histologic grade, expression of hormone receptors (estrogen and progesterone), and human epidermal growth factor receptor 2 (HER2) amplification.…”

Section: Discussionmentioning

confidence: 99%

Breast Cancer in Argentina: Feasibility for the Implementation of the New TNM Staging System 2018 in A Middle-Income Country

Kress¹

2018

J Can Epi Treat

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Background: Breast Cancer (BC) is the most commonly diagnosed cancer amongst women worldwide and also in Argentine a "medium human development" and "middleincome" country with an estimated incidence rate of 71, 2 per 100,000 in 2012. The implementation of the new TNM system for the staging of BC proposed by the AJCC and published in the VIII edition (2017) implies a substantial change with respect to the number of parameters and the criteria used until the present.

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Effect of mammographic screening from age 40 years on breast cancer mortality in the UK Age trial at 17 years' follow-up: a randomised controlled trial

Cited by 180 publications

References 29 publications

Updated results of the Gothenburg Trial of Mammographic Screening

Updated results of the Gothenburg Trial of Mammographic Screening

Implications of Overdiagnosis: Impact on Screening Mammography Practices

Breast Cancer in Argentina: Feasibility for the Implementation of the New TNM Staging System 2018 in A Middle-Income Country

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