Implementation of service screening with mammography in Sweden: from pilot study to nationwide programme

Olsson, Silas; Andersson, Ingvar; Karlberg, Ingvar; Bjurstam, Nils; Frodis, Ewa; Håkansson, Stefan

doi:10.1136/jms.7.1.14

Cited by 87 publications

(77 citation statements)

References 12 publications

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“…The average attendance rate in Sweden was 81% in 1995-96. 13 However, the attendance was lower (around 70%) in the 3 large cities (covering 19% of the Swedish population). Opportunistic screening exists in the large cities but is rare elsewhere, which might explain some of the differences in attendance rates.…”

Section: Methodsmentioning

confidence: 97%

Increased incidence of invasive breast cancer after the introduction of service screening with mammography in Sweden

Jonsson

Johansson

Lenner

2005

Intl Journal of Cancer

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Screening with mammography has been shown to substantially reduce mortality from breast cancer. The incidence of invasive cancer will increase as screening starts, and it is desirable that it gradually returns to the same level as before screening. Age-specific incidence of invasive breast cancer in 11 Swedish counties, including 463,000 women aged 40-74 years, was analysed before and after the start of service screening with mammography. Incidence, as observed on average during 12.8 years from screening start, was compared to expected incidence based on the incidence during a 15-year period preceding screening start. The height of the incidence peak during the first screening round was increasing with increasing age, compatible with the accumulation in the population of slowly growing tumours by age. All analysed age groups showed an increased ratio between observed stabilised incidence 7-14 years after screening start and expected incidence. When relative risks were adjusted for lead time, the estimates were 1.54 (95% confidence interval [CI] 1.33-1.79) and 1.21 (95% CI 1.04-1.41) for the age groups 50-59 and 60-69 years, respectively. In the age groups 40-49 and 70-74, no change was observed. The findings were further confirmed by the observation of a disappearance in the screened population of the notch in the increasing trend of age-specific breast cancer incidence for the ages after menopause. This notch could indicate hormone-related retardation in tumour growth around menopause. It appears that many of these clinically insignificant, retarded tumours are detected with screening mammography. ' 2005 Wiley-Liss, Inc.

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Section: Methodsmentioning

confidence: 97%

Increased incidence of invasive breast cancer after the introduction of service screening with mammography in Sweden

Jonsson

Johansson

Lenner

2005

Intl Journal of Cancer

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“…10 Invitation of women to screening has covered age groups of 40 to 74 years in counties with the widest range and from 50 to 69 years in those with the narrowest range; the screening intervals have varied from 18 to 24 months. Also other European countries initiated national mammographic screening schemes in the late 1980s, including Finland, the UK, the Netherlands and France.…”

Section: Methodsmentioning

confidence: 99%

Effects of screening for breast cancer on its age-incidence relationships and familial risk

Hemminki

Bermejo

2005

Int. J. Cancer

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Mammographic screening programs for breast cancer have been implemented in many countries and opportunistic mammographies are taken as a diagnostic method. The consequences of the wide application of this technology to age-incidence relationships in breast cancer have not been clarified nor is its effect on familial risk estimation. It was assumed that if screening and diagnostic methods bias familial risk, the highest risk should be noted for sisters diagnosed close in time. Age-specific incidence data were collected from the EUCAN database and from cancer registries of Finland, Norway and Sweden. The Swedish Family-Cancer Database was used to analyse risks for breast cancer among sisters, depending on the time since the first sister was diagnosed with breast cancer. Age-incidence patterns deviated between Germany, with low mammographic coverage, and Sweden, the Netherlands, the UK and France, with variable levels of coverage. The annual age-incidence patterns in Finland, Norway and Sweden changed in concert with the targeted mammographic service. The risk of breast cancer for women with an affected sister, diagnosed between ages 50 to 64 years, was significantly higher within the same or the subsequent year of the sister's diagnosis compared to 51 years, accounting for 7.3% of all patients. The ordered increase in age-specific incidence of breast cancer in the women targeted by screening studied suggests that mammographic screening is one important factor responsible for the shift of the age of onset for breast cancer towards middle age. However, the effects on the estimation of familial risk are so far small. ' 2005 Wiley-Liss, Inc.Key words: breast cancer; mammographic screening; age-incidence; familial risk Population screening for a cancer may cause major changes in its total and age-specific incidence, which has been witnessed for cervical cancer. 1,2 If the risk factors of a cancer remain constant, an effective screening should reduce disease-specific mortality. However, at least initially, the detection of asymptomatic tumours may cause an increase in incidence in the screened population, ''a screening effect'', which may either be due to an earlier diagnosis of tumours (lead time shift) or diagnosis of tumours that would never have been detected (true overdiagnosis). 3 In the course of introduction of screening technologies for breast cancer, the issue of overdiagnosis has been of focal interest and the subject of an unsettled debate, which we do not aim to address in the present work. [3][4][5][6][7] On the other hand, less attention has been paid to the changes in age-incidence relationships; data from Sweden and Norway show large increases in age groups that are targeted to screening. 6,8 These changes have taken place at the time when there has been an overall increase in the incidence of breast cancer in all the Western countries. For any cancer for which effective screening methods or methods for diagnosing early or latent tumours are being used, the possible interference with the concept of fami...

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“…In the Stockholm cohort, mode of detection of the CBC was classified into four groups: (a) clinical work-up, which included CBCs detected through the follow-up program, by either mammography or palpation performed by health care personal, (b) self-palpation performed by the patient, (c) the national breast cancer screening program [10,18] For further analysis, we also constructed an alternative binary variable 'clinical work-up including mammography screening' (yes/no), which contrasts modes a ? c against b ?…”

Section: Study Populationmentioning

confidence: 99%

“…Such a shift could have occurred due to improved diagnostic work-up and more intense follow-up of women with breast cancer, e.g., the opposite breast is examined more carefully and/or more often after a breast cancer diagnosis at present compared to earlier decades. An improvement like this could have several possible reasons: introduction of population-wide mammography screening [9,10], improvements in mammographic technique [11], and implementation of nationwide follow-up routines of breast cancer patients. Also, it can not be excluded that increased public awareness of breast cancer has contributed.…”

mentioning

confidence: 99%

Diagnostic work-up of contralateral breast cancers has not improved over calendar period

Sandberg

Hartman

Edgren

et al. 2010

Breast Cancer Res Treat

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Women who have been treated for breast cancer are typically followed up with regular mammography and palpation, with the aim of detecting recurrences and contralateral breast cancer (CBC). This study aims to investigate if the diagnostic work-up of breast cancer patients has improved over the last 25 years and resulted in earlier diagnoses of CBC. Two population-based cohorts were used; all CBCs in Sweden 1976Sweden -2004Sweden (n: 2932, and all CBCs in Stockholm, Sweden, 1976Sweden, -2005, both cohorts with a maximum of 3 years between the two cancers. Synchronous CBC was defined as two cancers \3 months apart, the remainder was defined as metachronous CBC. We calculated the odds ratio of being diagnosed synchronously, relative to metachronously, using logistic regression, adjusting for whether the second cancer was detected through clinical work-up or not. The odds of synchronous CBC were significantly increased: 1.27 (95% CI, 1.13-1.42) per 5-year period, compared to metachronous, and was not affected by detection mode, but seemed to be explained by adjuvant therapy. The proportion of CBCs detected by clinical work-up did not increase over the study period, and the mean size of the second tumor remained constant. We found an increase in the proportion of synchronous CBCs compared to metachronous, over calendar period, a change that was not associated with clinical work-up, but with adjuvant therapy. This study gives no indications that any improvement in diagnostic work-up of CBC have occurred over the last 25 years.

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Implementation of service screening with mammography in Sweden: from pilot study to nationwide programme

Cited by 87 publications

References 12 publications

Increased incidence of invasive breast cancer after the introduction of service screening with mammography in Sweden

Increased incidence of invasive breast cancer after the introduction of service screening with mammography in Sweden

Effects of screening for breast cancer on its age-incidence relationships and familial risk

Diagnostic work-up of contralateral breast cancers has not improved over calendar period

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