Screening for breast cancer with mammography

Gøtzsche, Peter C; Nielsen, Mie Femø

doi:10.1002/14651858.cd001877.pub3

Cited by 205 publications

(235 citation statements)

References 252 publications

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“…The quaternary prevention movement encompasses the current international movement against overmedicalization and has been endorsed by family doctors in South America (13)(14)(15), Europe (16)(17)(18), and Asia (19,20). The enthusiasm generated around this topic shows the P4 concept used as a framework for a multifaceted repositioning of current questions and limitations of medical practice: disease invention (21), Attention Deficit Hyperactivity Disorder (ADHD) market extension (22), transformation of symptoms into disease (23), osteoporosis marketing, doubt in breast cancer mass screening (24) and HPV immunization (25), drug marketing (26) as well as empathy and communication, the value of the symptoms, rational use of drug use in mental health, hypertension or dyslipidaemia or incidentaloma (27). And this list is not exhaustive (28).…”

Section: Quaternary Prevention Concept Expanding Worldwidementioning

confidence: 99%

Quaternary prevention, an answer of family doctors to overmedicalization

Jamoulle

2015

Int J Health Policy Manag

104

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In response to the questioning of Health Policy and Management (HPAM) by colleagues on the role of rank and file family physicians in the same journal, the author, a family physician in Belgium, is trying to highlight the complexity and depth of the work of his colleagues and their contribution to the understanding of the organization and economy of healthcare. It addresses, in particular, the management of health elements throughout the ongoing relationship of the family doctor with his/her patients. It shows how the three dimensions of prevention, clearly included in the daily work, are complemented with the fourth dimension, quaternary prevention or prevention of medicine itself, whose understanding could help to control the economic and human costs of healthcare.

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Section: Quaternary Prevention Concept Expanding Worldwidementioning

confidence: 99%

Quaternary prevention, an answer of family doctors to overmedicalization

Jamoulle

2015

Int J Health Policy Manag

104

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“…This was supported by a metaanalysis of the four Swedish trials in 1993 that reported a 29% reduction in the age group 50-69 years [2]. In the UK population, a 25% reduction in breast cancer mortality was expected by the year 2000 [3,4], and the American Cancer Society expected a 50% reduction by 2015 [5].However, most of the randomised trials are of poor quality [6,7], and comprehensive systematic reviews performed by The Nordic Cochrane Centre and the US Preventive Services Task Force have suggested that the effect was only a 15-16% reduction in breast cancer mortality [7][8][9].Observational studies from 2010 have made it clear that even this modest estimate has been too optimistic. The most robust study is from Denmark, which has a unique control group, as only 20% of the rather homogeneous population was screened throughout 17 years [10].…”

mentioning

confidence: 99%

“…However, most of the randomised trials are of poor quality [6,7], and comprehensive systematic reviews performed by The Nordic Cochrane Centre and the US Preventive Services Task Force have suggested that the effect was only a 15-16% reduction in breast cancer mortality [7][8][9].…”

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confidence: 99%

Why mammography screening has not lived up to expectations from the randomised trials

Gøtzsche

Jørgensen

Zahl

et al. 2011

Cancer Causes Control

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We analysed the relation between tumour sizes and stages and the reported effects on breast cancer mortality with and without screening in trials and observational studies. The average tumour sizes in all the trials suggest only a 12% reduction in breast cancer mortality, which agrees with the 10% reported in the most reliable trials. Recent studies of tumour sizes and tumour stages show that screening has not lowered the rate of advanced cancers. In agreement with this, recent observational studies of breast cancer mortality have failed to find an effect of screening. In contrast, screening leads to serious harms in healthy women through overdiagnosis with subsequent overtreatment and false-positive mammograms. We suggest that the rationale for breast screening be urgently reassessed by policy-makers. The observed decline in breast cancer mortality in many countries seems to be caused by improved adjuvant therapy and breast cancer awareness, not screening. We also believe it is more important to reduce the incidence of cancer than to detect it 'early.' Avoiding getting screening mammograms reduces the risk of becoming a breast cancer patient by one-third.

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“…Ypač daug apie KV chemoprevenciją kalbama JAV (19)(20)(21) Cochrane collaboration 2009 m. paskelbtais duome nimis, mamografinė patikra sumažino mirš-ta mumą nuo krūties vėžio 15 %, bet padidino nerimą ir nebūtinų chirurginių ekscizijų skaičių. Tačiau dauguma tarptautinių organizacijų rekomenduoja profilaktiškai atlikti mamografiją kas 2 metus 50-74 m. moterims (28).…”

Section: Mirštamumas Nuo Krūties Vėžiounclassified

Krūties vėžys Lietuvoje

Gudavičienė¹,

Steponavičienė²,

Lachej³

2015

AML

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Įvadas. Krūties vėžys -viena dažniausių moterų onkologinių ligų Lietuvoje. Pastaraisiais metais krūties vėžį pagal dažnį lenkia tik odos piktybiniai susirgimai. Krūties vėžio gydymo rezultatai Lietuvoje nėra džiu-ginantys. Krūties vėžys -pagrindinė moterų mirštamumo priežastis dėl onkologinių susirgimų. Tai paskatino apžvelgti krūties vėžio paplitimą, sergamumo ir mirštamumo nuo krūties vėžio pokyčius Lietuvoje, palyginti Lietuvos tendencijas su kitų šalių rezultatais. Bandyta išsiaiškinti priežastis, kodėl negerėja išgyvenamumo rezultatai.Medžiaga ir metodika. Remdamiesi Lietuvos vėžio registro duomenimis, analizavome sergamumo ir mirštamumo nuo krūties vėžio duomenis ir tendencijas Lietuvoje, palyginome Lietuvos statistinius duomenis su pasaulio duomenimis. Nagrinėjome paskelbtas apklausas apie profilaktines patikros programas. Norėdami sužinoti, kaip veikia profilaktinės patikros programa, išanalizavome pagal programą tikrintų moterų Nacionaliniame vėžio institute duomenis. Pagrindinis informacijos šaltinis, ieškant duomenų, buvo Lietuvos vėžio registro bei PubMed bei Medscape duomenų bazės.Rezultatai. Pagal profilaktinę patikros programą pasitikrina tik treč-dalis tikslinės grupės moterų. Neretai pagal programą siunčiamos tikrintis moterys, kurių krūties susirgimo požymiai yra akivaizdūs. Išgyvena-mumo rodikliai gydant krūties vėžį Lietuvoje yra blogesni, palyginti su išsivysčiusiomis Vakarų Europos šalimis. Taip gali būti dėl nepakankamai anksti nustatomų pakitimų ir nepakankamai modernaus gydymo.Išvados. Norint pagerinti sergančiųjų krūties vėžiu išgyvenamumą Lietuvoje, svarbu kuo anksčiau nustatyti šią ligą, gydymo taktiką aptarti multidisciplininėje komandoje, o pacientėms turi būti prieinamas modernus gydymas. Profilaktinės krūtų patikros teigiamą poveikį pacienčių išgyvenamumui tikimės pajusti artimiausiais metais. Reikia šviesti visuomenę ir šeimos gydytojus apie krūties vėžį, diagnostikos ir gydymo tendencijas bei naujoves. Raktažodžiai: krūties vėžys, dažnis, mirštamumas, profilaktinės patikros programa KRŪTIES VĖŽIO PAPLITIMASKrūties vėžys (KV) atsiranda dėl nekontroliuojamo, nenormalaus krūties ląstelių dalijimosi. Šis procesas prasideda dėl "klaidos" genuose. 5-10 % tokių "klaidų" yra paveldimos, apie 90 % genų pažeidimas atsiranda individo gyvenimo metu. Skandinavijos epidemiologai prognozuoja, kad 2020 m. onkologinės ligos taps pagrindine mirties priežastimi, o sergamumas vėžiu aplenks sergamumą širdies ir kraujagyslių ligomis. Lietuvos vėžio

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Screening for breast cancer with mammography

Cited by 205 publications

References 252 publications

Quaternary prevention, an answer of family doctors to overmedicalization

Quaternary prevention, an answer of family doctors to overmedicalization

Why mammography screening has not lived up to expectations from the randomised trials

Krūties vėžys Lietuvoje

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