Randomized study of mammography screening — preliminary report on mortality in the stockholm trial

Abstract

In March 1981, 40,318 women in Stockholm, aged 40-64, entered a randomized trial of breast cancer screening by single-view mammography alone versus no intervention in a control group of 20,000 women. The attendance rate during the first screening round was 81 per cent and the cancer detection rate was 4.0 per 1000 women. The detection the rate fell to 3.1 per 1000 in the second round, which was completed in October 1985. During 1986 the controlled design of the study was broken and the control women were invited once to screening which was completed the same year. A total of 428 cases of breast cancer were thus diagnosed in the study group and 439 in the adjusted control group. After a mean follow-up of 7.4 years the number of breast cancer deaths in the study and control groups was 39 and 30 respectively. The relative risk of breast cancer death (screening versus control) was 0.71 (95 per cent confidence interval: 0.4-1.2). Among women older than 50 years at entry the relative risk was 0.57 (95 percent confidence interval: 0.3-1.1). Cancer deaths among women under 50 were few and perhaps because of this no mortality reduction was seen in this age group. The estimate of mortality reduction lies between the results from two earlier Swedish randomized controlled trials.

Histopathologic and Cytochemical Characteristics of Interval Breast Carcinomas from the Stockholm Mammography Screening Project

“…Yet unpublished data from the Stockholm mammography screening trial rather indicate a higher overall survival in patients with interval cancer compared to patients with clinically detected cancers belonging to the control group. However, as has been shown in the recent report on mortality on the Stockholm trial (22), 17 (44%) of the 39 breast cancer deaths in the study (i.e. screened) population belonged to the interval group.…”

Systematic review of the psychological consequences of false-positive screening mammograms

“…On top of this, for the same cohort, at least another 200 women would go through the possible distress of a false-positive outcome. 16 Of the eight eligible trials in the Gotzsche and Nielsen review 16 (New York 1963, [17][18][19] Malmo 1976 [20][21][22] and Malmo II 1978, 23 Two-County 1977, [24][25][26] Edinburgh 1978, [27][28][29] Canada 1980, [30][31][32][33] Stockholm 1981, [34][35][36][37] Goteborg 1982 38,39 and UK Age Trial 1991 [40][41][42][43][44] ), one was excluded from meta-analysis because the randomisation was seriously flawed and the data held to be unreliable (Edinburgh 1978 28,29 ). Gotzsche and Nielsen 16 found that only three of the remaining trials had adequate randomisation.…”

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

“…1 For women ≥ 50 years of age, breast cancer screening tests are beneficial and decrease mortality. [2][3][4][5][6] Physicians' cancer screening recommendations are a key factor that determines whether women actually receive cancer screening tests. [7][8][9][10][11] Major guidelines, including those written by the U.S. Preventive Services Task Force (USPSTF), the American College of Obstetrics and Gynecology (ACOG), and the American Cancer Society (ACS), recommend mammography as the only routine screening test for women ≥50 years of age who are not at high risk of breast cancer.…”