Effect of NHS breast screening programme on mortality from breast cancer in England and Wales, 1990-8: comparison of observed with predicted mortality

Abstract

Objective To assess the impact of the NHS breast screening programme on mortality from breast cancer in women aged 55-69 years over the period 1990-8. Design Age cohort model with data for 1971-89 used to predict mortality for 1990-8 with assumption of no major effect from screening or improvements in treatment until after 1989. Effect of screening and other factors on mortality estimated by comparing three year moving averages of observed mortality with those predicted (by five year age groups from 50-54 to 75-79), the effect of screening being restricted to certain age groups. Setting England and Wales. Subjects Women aged 40 to 79 years. Results Compared with predicted mortality in the absence of screening or other effects the total reduction in mortality from breast cancer in 1998 in women aged 55-69 was estimated as 21.3%. Direct effect of screening was estimated as 6.4% (range of estimates from 5.4-11.8%). Effect of all other factors (improved treatment with tamoxifen and chemotherapy, and earlier presentation outside the screening programme) was estimated as 14.9% (range 12.2-14.9%). Conclusions By 1998 both screening and other factors, including improvements in treatment, had resulted in substantial reductions in mortality from breast cancer. Many deaths in the 1990s will be of women diagnosed in the 1980s and early 1990s, before invitation to screening. Further major effects from screening and treatment are expected, which together with cohort effects should result in further substantial reductions in mortality from breast cancer, particularly for women aged 55-69, over the next 10 years.

Declining mortality from breast cancer in Yorkshire, 1983–1998: extent and causes

“…Recent time trends in the incidence and mortality of breast cancer in Yorkshire follow the general pattern of that reported for the UK overall (Northern & Yorkshire Cancer Networks, 1999;Blanks et al, 2000). Incidence and mortality trends have been diverging since the mid-1980s, indicating important improvements in the prognosis of the disease.…”

The low uptake of breast screening in cities is a major public health issue and may be due to organisational factors: A Census-based record linkage study

“…2,3,4 The effectiveness of screening programmes depends on rates of participation but routine information on variations in uptake rates is limited and a recent systematic review of studies on inequalities in access to cancer services reported that there was a dearth of information about the factors related to screening uptake in the UK. 5 The need for more detailed information on the sources of variation in uptake of screening services has been highlighted in the final report of the Equalities Review 6 and the National Screening Programmes Information Strategy.…”

Breast cancer mortality trends in two areas of the province of Florence, Italy, where screening programmes started in the 1970s and 1990s

“…Mammographic screening has been shown to reduce breast cancer mortality rates (Vainio and Bianchini, 2002). Several studies in northern European countries (Hermon and Beral, 1996;Hakama et al, 1997; Van den Akker-van Marle et al, 1999;Blanks et al, 2000;Jonsson et al, 2001;Botha et al, 2003;Otto et al, 2003;Tabar et al, 2003) have reported a decrease in breast cancer mortality where nationwide screening programmes have been implemented. There has, however, been considerable debate concerning the relative contributions of screening and of improved therapy to the observed trends (Carnon et al, 1996;Blanks et al, 2000;Peto et al, 2000).…”

“…Several studies in northern European countries (Hermon and Beral, 1996;Hakama et al, 1997; Van den Akker-van Marle et al, 1999;Blanks et al, 2000;Jonsson et al, 2001;Botha et al, 2003;Otto et al, 2003;Tabar et al, 2003) have reported a decrease in breast cancer mortality where nationwide screening programmes have been implemented. There has, however, been considerable debate concerning the relative contributions of screening and of improved therapy to the observed trends (Carnon et al, 1996;Blanks et al, 2000;Peto et al, 2000).At the beginning of the 1970s in 23 rural municipalities of the province of Florence, Italy (early screening area (ES area) among about 70 000 resident women aged 25 or over, 18% of women of the province, based on 1991 Census), a mammographic screening programme was started; until 1989, women in the 40 -69 year age group were invited, whereas from that year onwards the target population was restricted to age group 50 -69 years. The number of mammograms performed in the ES area was 8000 -9000 per year.…”