14 years of follow-up from the Edinburgh randomised trial of breast-cancer screening

Alexander, Freda E.; Anderson, Thomas; Brown, Helen; Forrest, A. P. M.; Hepburn, W.; Kirkpatrick, A. E.; Muir, B. B.; Prescott, R. J.; Smith, A. F.

doi:10.1016/s0140-6736(98)07413-3

Cited by 347 publications

(161 citation statements)

References 20 publications

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“…There was no reduction in breast cancer mortality in the 50‐ to 54‐year age group and a 30% reduction in the 55‐ to 59‐year age group (data not shown). The reason for this is not clear, but a similar phenomenon has been observed in other studies 13, 14, 15. It may be that starting screening at this perimenopausal time of life when the breast tissue is changing rapidly is a greater challenge for radiology.…”

Section: Discussionsupporting

confidence: 74%

Updated results of the Gothenburg Trial of Mammographic Screening

Bjurstam

Björneld

Duffy

2016

Cancer

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BACKGROUNDThere remain uncertainties about age‐specific effects of breast cancer screening on mortality due to the disease.METHODSIn 1982, a randomized trial of mammographic screening every 18 months was started in Gothenburg, Sweden. Women between the ages of 39 and 49 years were randomized to an invitation to screening (intervention group; n = 11,792) or to usual care (the control group; n = 14,321). The corresponding numbers for women between the ages of 50 and 59 years were 10,112 and 15,997. Follow‐up data for breast cancer mortality were available up to the end of 2007. Data were analyzed by Poisson regression with conservative variance estimates.RESULTSThere were 79 breast cancer deaths in the intervention arm and 156 in the control arm, and this meant a significant 30% reduction in breast cancer mortality with the offer of screening (relative risk [RR], 0.70; 95% confidence interval [CI], 0.53‐0.93; P = .01). In women aged 39 to 49 years, there was a significant 40% reduction in breast cancer mortality (RR, 0.60; 95% CI, 0.43‐0.85; P = .003). In the 50‐ to 59‐year age group, there was a nonsignificant 18% breast cancer mortality reduction (RR, 0.82; 95% CI, 0.54‐1.26; P = .4).CONCLUSIONSThe policy of offering mammographic screening substantially reduces breast cancer mortality and can do so in women younger than 50 years. Cancer 2016;122:1832–5. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

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Section: Discussionsupporting

confidence: 74%

Updated results of the Gothenburg Trial of Mammographic Screening

Bjurstam

Björneld

Duffy

2016

Cancer

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“…6 Mean treatment costs per tumour stage. 7 Estimate from de Koning et al 1992 38 indexed to current price levels.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

“…[2][3][4] Furthermore, Otto et al 5,6 showed that the Dutch population-based screening programme is effective in reducing breast cancer mortality. The evidence for the benefit of mammography screening for younger women is less conclusive, [7][8][9] however, an effect for this age group is supported by several studies. Although the UK Age Trial showed a non-significant 17% reduction in breast cancer mortality, 9 a statistically significant breast cancer mortality reduction of 15% to 18% associated with screening for women aged 39 to 49 or 40 to 49 at entry was demonstrated by several meta-analyses of randomised controlled trials.…”

mentioning

confidence: 99%

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Sankatsing

Heijnsdijk

Luijt

et al. 2015

Intl Journal of Cancer

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In the Netherlands, routine mammography screening starts at age 50. This starting age may have to be reconsidered because of the increasing breast cancer incidence among women aged 40 to 49 and the recent implementation of digital mammography. We assessed the cost-effectiveness of digital mammography screening that starts between age 40 and 49, using a microsimulation model. Women were screened before age 50, in addition to the current programme (biennial 50-74). Screening strategies varied in starting age (between 40 and 50) and frequency (annual or biennial). The numbers of breast cancers diagnosed, life-years gained (LYG) and breast cancer deaths averted were predicted and incremental cost-effectiveness ratios (ICERs) were calculated to compare screening scenarios. Biennial screening from age 50 to 74 (current strategy) was estimated to gain 157 life years per 1,000 women with lifelong follow-up, compared to a situation without screening, and cost e3,376/ LYG (3.5% discounted). Additional screening increased the number of LYG, compared to no screening, ranging from 168 to 242. The costs to generate one additional LYG (i.e., ICER), comparing a screening strategy to the less intensive alternative, were estimated at e5,329 (biennial 48-74 vs. current strategy), e7,628 (biennial 45-74 vs. biennial 48-74), e10,826 (biennial 40-74 vs. biennial 45-74) and e18,759 (annual 40-49 1 biennial 50-74 vs. biennial 40-74). Other strategies (49 1 biennial 50-74 and annual 45-49 1 biennial 50-74) resulted in less favourable ICERs. These findings show that extending the Dutch screening programme by screening between age 40 and 49 is cost-effective, particularly for biennial strategies.Breast cancer is the most commonly diagnosed form of cancer among women aged 30 and older in the Netherlands. 1 Mammography screening allows for early detection and early treatment of breast cancer, with the aim of averting breast cancer death. In the Netherlands, women aged 50 to 74 are invited biennially to screening. Various randomised controlled trials demonstrated a statistically significant breast cancer mortality reduction due to mammography screening in this age group. 2-4 Furthermore, Otto et al. 5,6 showed that the Dutch population-based screening programme is effective in reducing breast cancer mortality. The evidence for the benefit of mammography screening for younger women is less conclusive, 7-9 however, an effect for this age group is supported by several studies. Although the UK Age Trial showed a non-significant 17% reduction in breast cancer mortality, 9 a statistically significant breast cancer mortality reduction of 15% to 18% associated with screening for women aged 39 to 49 or 40 to 49 at entry was demonstrated by several meta-analyses of randomised controlled trials. [10][11][12][13] In addition, a recent Swedish observational study that compared breast cancer mortality rates between women aged 40 and 49 who were invited to screening and women who were not invited to screening demonstrated a 26% statistically significant br...

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“…Screening mammography reduces breast cancer mortality (Chu et al, 1988;Chu and Connor, 1991;Nystrom et al, 1993;Kerlikowske et al, 1995;Bjurstam et al, 1997;Alexander et al, 1999;Tabar et al, 2000;Black et al, 2002;Nystrom et al, 2002). A meta-analysis of the randomised screening trials found equivalent mortality reductions (23%) from approximate annual screening compared to screening every 18 -33 months (Kerlikowske et al, 1995).…”

mentioning

confidence: 99%

Comparison of 1- and 2-year screening intervals for women undergoing screening mammography

et al. 2005

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We compared the long-term impact of 1-and 2-year screening mammography intervals using prognostic, screening, and outcome information for women aged 50 -74 years obtained from the Screening Mammography Program of British Columbia in two time periods, prior to 1997 (policy of annual mammography) and after 1997 (biennial mammography). Survival was estimated for both periods using a prognostic model and the expected rate of interval and screen-detected cancers. The likelihood of a screen-detected cancer with annual screening was 2.32 per thousand screens and with biennial screening was 3.32 per thousand screens. The prognostic profile of screen-detected cancers was better than that of interval cancers. Among both screen-detected and interval cancers, the prognostic profiles with annual and biennial screening were similar. The estimated breast cancer-specific survival rates for women undergoing annual and biennial screening mammography were 95.2 and 94.6% at 5 years, and 90.4 and 89.2% at 10 years, respectively. Annual compared to biennial mammography was associated with a 1.2% increase in the estimated 10-year breast cancer-specific survival for women aged 50 -74 years, diagnosed with invasive breast cancer after screening programme attendance.

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14 years of follow-up from the Edinburgh randomised trial of breast-cancer screening

Cited by 347 publications

References 20 publications

Updated results of the Gothenburg Trial of Mammographic Screening

Updated results of the Gothenburg Trial of Mammographic Screening

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Comparison of 1- and 2-year screening intervals for women undergoing screening mammography

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