Using the European guidelines to evaluate the Norwegian Breast Cancer Screening Program

Hofvind, Solveig; Geller, Berta M.; Vacek, Pamela M.; Thoresen, Steinar; Skaane, Per

doi:10.1007/s10654-007-9137-y

Cited by 115 publications

(132 citation statements)

References 22 publications

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“…This increase and the increase in detection of tumors less than or equal to 20 mm in the screening period, is probably mainly related to the implementation of the screening program, but also because of improved equipment, more experienced radiologists, and increased attention towards breast cancer and mammography in general. A previous study from Norway, where all screen and interval cancers in this study are included, shows close correlation between grading and lymph node involvement with tumor size [7]. The negative correlation between tumor size and survival is well known for invasive cases [9,18], and a mathematical model by Michaelson et al shows that the chance of dying from breast cancer increases by 1% for every additional mm of tumor diameter [19].…”

Section: Discussionsupporting

confidence: 56%

“…The NBCSP is described in details elsewhere [6,7]. In short, the program is an organized population-based screening program inviting all Norwegian women aged 50Á69 years, by a personal letter, to a stated place and time for bilateral two-view mammography biennially.…”

Section: The Norwegian Breast Cancer Screening Programmentioning

confidence: 99%

“…The program utilizes independent double reading with consensus. During the first ten years of performance, a total of 1 390 310 invitations were sent whereas 1 059 309 screens were performed (76.2%) [7]. The screening detection rate was 5.5 per 1 000 screens and the interval cancer rate 1.9 per 1 000 screens.…”

Section: The Norwegian Breast Cancer Screening Programmentioning

confidence: 99%

“…The program gradually expanded and became nationwide in 2004. About half a million women aged 50Á69 years are biennially invited to a two view mammography of 2007 [6,7]. Due to the recent nationwide coverage, the program is in the phase of evaluating performance and early surrogate measures, which can be considered as an alternative to, and preparation for analyzing the mortality [5].…”

mentioning

confidence: 99%

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Incidence and tumor characteristics of breast cancer diagnosed before and after implementation of a population-based screening-program

2008

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Section: Discussionsupporting

confidence: 56%

Section: The Norwegian Breast Cancer Screening Programmentioning

confidence: 99%

Section: The Norwegian Breast Cancer Screening Programmentioning

confidence: 99%

mentioning

confidence: 99%

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Incidence and tumor characteristics of breast cancer diagnosed before and after implementation of a population-based screening-program

2008

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“…Although European guidelines do not specify an upper limit on the desirable levels, a high breast cancer detection rate may suggest a longer sojourn time (the period in which the tumour is asymptomatic but detectable by screening) than expected and diagnosis of cancers that would not have been detected without screening. 52 However, over diagnosis has to be evaluated carefully with tumour characteristics in mind.…”

Section: Discussionmentioning

confidence: 99%

A retrospective audit of the first screening round of the Maltese breast screening programme

2017

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Purpose: To analyse whether the screening performance parameters of the Maltese National Breast Screening Programme first screening round met requirements set by European standards. The association between screening age and results of screening performance parameters was also investigated. Method:Quantitative methodology was used to review examinations of women who were recalled for a technical recall or further assessment rates. All accessible members of the population recalled during the first round were retrospectively reviewed resulting in a sample of 2300 recalled examinations.Results: Malta's first screening round met the European Guidelines recommendations for technical repeat rate (0.26%), early recall rate (0.45%), breast cancer detection rate (13.77 per 1000 women) and Positive Predictive Value of screening test (7.58%). However, local recall rate (18.53%) and further assessment rate (18.27%) were higher than recommended.The Chi square test showed a statistically significant difference (p<0.05) in recall rates between the compared age groups, as younger women (51-55 years) were more likely to have a negative diagnosis after the initial mammogram whereas older women (56-60 years) were more likely to be recalled. There was no age discrepancy (p>0.05) in local breast cancer detection rate and positive predictive value of screening test. Conclusion:Although the Maltese first screening round performed well, this study found deficiencies in recall and further assessment rates, which according to literature may result in psychological morbidity and inefficient use of screening resources. This study also concluded that when a cohort is analysed, age is not as significant as the screening round itself (first/subsequent). KeywordsBreast cancer, breast screening programme, screening performance parameter, false positive mammogram, age effect IntroductionBreast cancer is the most common cancer among Maltese women and accounts for a third of all female cancer deaths. Every one in twelve Maltese women will get breast cancer in her lifetime; a significantly higher proportion than the European average. 1 In October 2009, Malta's Department for Health agreed to implement a National Breast Screening Programme (MNBSP). 2 The aim of screening was to reduce morbidity and mortality from the disease without adversely affecting the health of participants. 3,4 Key to achieving this aim were high levels of quality within the entire screening process. 4 The MNBSP strives to protect the dignity and privacy of women, while offering an effective service at the highest levels of quality to diagnose and treat breast cancers at the earliest possible stage, and also meeting the European clinical standards. 4 The first MNBSP round commenced in October 2009 and ended in February 2013. The local screening programme provided free screening, every three years for all women aged 50 to 60, resident in the Maltese Islands. This age range was selected for the first screening round since this age group was deemed to be the 'most at risk'...

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Hormone Therapy Use May Explain Recent Results Regarding Tumor Regression

2009

Arch Intern Med

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COMMENTS AND OPINIONS Spontaneous Regression of Breast CancerT he recent article published by Zahl et al 1 brought up some very interesting discrepancies in incidence rates of invasive breast cancer between screened and unscreened groups of women in the Norwegian Breast Cancer Screening Program. At the end of the study, there was a much lower rate of invasive breast cancer diagnosed in the unscreened group, which the authors contribute to spontaneous regression. According to their theory, if all invasive tumors that develop are persistent, then at the end of the study period, the screened group and the control group should have a similar incidence, and since this is not observed, then some tumors must spontaneously regress.The authors test a lot of alternative theories to their conclusions and seem to prove that their theory still holds. However, there is a potentially fatal mistake that the authors make when refuting the alternative hypothesis that hormone therapy (HT) differences between the 2 groups can account for the observed difference in invasive breast cancer incidence. The authors assume that HT accounts for a 24% increase in the diagnosis of invasive breast cancer, and they base this assumption on the conclusions from the Women's Health Initiative study, which was conducted on a group of US women. 2 Based on this assumption, as the authors point out in their study, a 24% increase cannot account for the observed difference seen in their study. Unfortunately, previous research has shown that Norwegian women have substantially higher rates of invasive breast cancer due to HT than US women. A study published by Hofvind et al, 3 which analyzed essentially the same screened group of women as did Zahl et al, 1 found that attributable risk due to HT in the population of Norwegian women was 58%. In this scenario, if we use the most extreme example used by Zahl et al 1 in which there was no HT use in the control group and 46 000 women in the screened group with HT use (58%ϫ46 000/119 000=22.4%), then the observed difference based on HT alone would account for a 22% difference in cumulative incidence. Therefore, according to this most extreme example, the entire difference seen in the cumulative incidence of invasive breast cancer between the screened group and the control group could be due to HT alone and have nothing to do with spontaneous regression.

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Using the European guidelines to evaluate the Norwegian Breast Cancer Screening Program

Cited by 115 publications

References 22 publications

Incidence and tumor characteristics of breast cancer diagnosed before and after implementation of a population-based screening-program

Incidence and tumor characteristics of breast cancer diagnosed before and after implementation of a population-based screening-program

A retrospective audit of the first screening round of the Maltese breast screening programme

Hormone Therapy Use May Explain Recent Results Regarding Tumor Regression

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