BACKGROUND The evaluation of organized mammographic service screening programs is a major challenge in public health. In particular, there is a need to evaluate the effect of the screening program on the mortality of breast carcinoma, uncontaminated in the screening epoch by mortality from 1) cases diagnosed in the prescreening period and 2) cases diagnosed among unscreened women (i.e., nonattenders) after the initiation of organized screening. METHODS In the current study, the authors ascertained breast carcinoma deaths in the prescreening and screening epochs in 7 Swedish counties from tumors diagnosed in these epochs and in the age group 40–69 years in 6 counties and 50–69 years in 1 county. Data regarding deaths were obtained from the Uppsala Regional Oncologic Center in conjunction with the National Cause of Death Register. The total number of women in the eligible age range living in each county was obtained from the annual population data of Statistics Sweden. Detailed screening data were provided by the screening centers in the seven counties, including the number of invited, the number attended, and whether each individual breast carcinoma case was exposed (screen‐detected and interval cases combined) or unexposed (not‐invited or nonattenders) to mammographic screening. There were 2044 breast carcinoma deaths from 14,092 incident tumors diagnosed in the prescreening and screening epochs, and the total number of person‐years was 7.5 million. Data were analyzed using Poisson regression with corrections for self‐selection bias and lead‐time bias when appropriate. RESULTS The mortality reduction for breast carcinoma in all 7 counties combined for women actually exposed to screening compared with the prescreening period was 44% (relative risk [RR] = 0.56; 95% confidence interval [95% CI], 0.50–0.62). When all incident tumors were considered, both those exposed and those unexposed to screening combined, counties with > 10 years of screening were found to demonstrate a significant 32% mortality reduction (RR = 0.68; 95% CI, 0.60–0.77) and counties with ≤ 10 years of screening showed a significant 18% reduction in breast carcinoma mortality (RR = 0.82; 95% CI, 0.72–0.94) for the screening epoch compared with the prescreening epoch. Within the screening epoch, after adjustment for self‐selection bias, a 39% mortality reduction (RR = 0.61; 95%CI, 0.55–0.68) was observed in association with invitation to screening. CONCLUSIONS Organized service screening in 7 Swedish counties, covering approximately 33% of the population of Sweden, resulted in a 40–45% reduction in breast carcinoma mortality among women actually screened. The policy of offering screening is associated with a mortality reduction in breast carcinoma of 30% in the invited population, exposed and unexposed combined. The results of the current study indicate that the majority of the breast carcinoma mortality reduction is indeed due to the screening. [See editorial on pages 451–7, this issue.] Cancer 2002;95:458–69. © 2002 American Cancer Socie...

The aim of the present study was to analyse the survival rate in a group of breast cancers detected in the intervals between screening examinations in relation to clinically detected cancers in a non-screened population. All interval and control cancers were recruited from a randomized controlled mammography screening trial in Stockholm. The overall survival up to eight years of observation was higher in 191 patients with interval cancers than in 142 control cancers (p = 0.01). There were no significant differences between the two groups with regard to tumor size, stage distribution, or mean age, though the interval group did have a larger proportion of younger women. The similarity was confirmed by multiple regression analysis. The overall survival stage by stage was consistently higher in interval cancers. The survival rate in the true interval cancers was similar to that for those found in retrospect to have been detectable or traceable at the time of screening. No correlation was found between the length of the interval and the survival of patients with interval cancers. These results contradict the hypothesis that a high growth rate is associated with a poorer prognosis and that interval cancers are a more aggressive form of breast neoplasia.

The main purpose of this study was to evaluate the relationship between the radiologic findings in clinically successful Charnley total hip replacements (THR) at an average of five years postoperatively ('5-year follow-up') and the clinical result 10 to 14 years after operation ('to-year follow-up'). The study included 150 arthroplasties graded as clinically successful at the 5-year followup despite radiologic loosening of the femoral component in 41 per cent and of the acetabular component in 7 per cent. The incidence of clinical failure between the two follow-ups was 7 per cent (10 hips). Only 2 per cent (3/125) of THRs with intact components or a loose stem with migration not exceeding 4 mm became failures. Clinical failures resulted in 28 per cent (7/25) of THRs with more extensive loosening of the stem or with a loose socket. At the to-year follow-up 47 per cent of the femoral and 13 per cent of the acetabular components were loose. Progression of loosening of the femoral stem occurred in 63 per cent and of the socket in 73 per cent between the two follow-ups. The incidence of loosening of the stem showed a significant correlation both with the extent of cementation distal to the tip and with the orientation of the prosthesis in the sagittal plane.The rate of deep infection following total hip replacement (THR) has been reduced to a relatively low level by prophylactic measures, and clinical deterioration today is usually caused by loosening of the components. However, radiologically loose components do not necessarily entail clinical deterioration. Several studies have shown that the clinical results of THR more than 10 years postoperatively are in most cases satisfactory (8, 16), despite the fact that several authors (l, 3, 10) have reported a relatively high incidence (24-39 %) of radiologic loosening of the femoral component as early as 3 to 5 years postoperatively. The main purpose of this study was to determine whether a correlation existed between the radiologic findings in hips assessed as clinically successful at an average of five years postoperatively ('5-year follow-up') and the clinical results in these hips 10 to 14 years after operation ('lO-year follow-up'), and in addition to study the relationship between radiologic and clinical findings at the IO-year follow-up. Material and MethodsThe original consecutive series consisted of 325 Charnley THR inserted in 296 patients (201 in 183 women and 124 in 113 men) between February 1968 and January 1972. The mean age at operation was 64.4 years. The main indications for THR were osteoarthritis (63%), late complications to femoral neck fracture (18%), and rheumatoid arthritis (11%). Previous surgery had been performed in 87 hips (27%). A Charnley 'flat-back' femoral component and an ultra high density polyethylene acetabular cup were used together with radiopaque CMW bone cement in all cases. At that time the surgeons were not sufficiently aware of the importance of the cementation technique for the long-term results, and the medullary canal was usual...

The relationship between mammographic appearance of microcalcifications and tumor stage, malignancy grade, estrogen receptor (ER) content and nuclear DNA pattern was studied in 92 mammary carcinomas. The results indicate that no complementary prognostic guidance can be obtained from the radiographic appearance of a tumor apart from a high probability of a spiculated cancer being ER-rich. The finding of a relatively high proportion of aneuploid and ER-poor carcinomas among tumors with microcalcifications indicates that this radiographic characteristic might be associated with increased growth potential.