Nation-wide breast cancer screening in The Netherlands: Results of initial and subsequent screening 1990–1995

Fracheboud, Jacques; Koning, Harry J. de; Beemsterboer, Petra M. M.; Boer, Rob; Hendriks, Jan H. C. L.; Verbeek, A.L.M.; Ineveld, B. Martin van; Bruyn, A. E. De; Maas, P.J. van der

doi:10.1002/(sici)1097-0215(19980302)75:5<694::aid-ijc6>3.0.co;2-u

Cited by 113 publications

(72 citation statements)

References 17 publications

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“…8 The current result may at least partially indicate differences in diagnostic and treatment practices within and/or outside the organised screening. Noteworthy, studies on organised mammography from the Netherlands have reported low recall rates (0.7-1.3%), 23,24 reduced rates of advanced cancers, 25 and similar impact on the breast cancer mortality as the current study. 13 Thus it is possible that indicators of screening performance may be of limited use in predicting the quantity of mortality reduction.…”

Section: Comparison Of Results To Other Studiessupporting

confidence: 61%

Organised mammography screening reduces breast cancer mortality: A cohort study from Finland

Sarkeala

Heinävaara

Anttila

2007

Intl Journal of Cancer

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We evaluated the effectiveness and the efficacy of populationbased mammography programme in Finland, and explored associations between the screening performance and the screening efficacy. The main outcome, incidence-based mortality from breast cancer, was estimated by invitation, participation, age at death, and screening centres categorised by recall rates. The study was based on an individual followup of screening invitees and participants from 1992 to 2003. The coverage of screening invitations was 95% among 50-59 years old women, and 20-40% among women aged 60-69 years. We compared observed deaths from breast cancer to expected breast cancer deaths without screening in ages 50-69 at death. The observed deaths were obtained from a cohort of individual invitees (n 5 361,848). The expected deaths were defined by modelling breast cancer mortality from 1974 to 1985 and 1992 to 2003 at population level. The population data were derived from the same municipalities (n 5 260) that were incorporated into the cohort. The breast cancer mortality among the invited women was reduced by 22% (relative risk 0.78, 95% confidence interval 0.70-0.87). After adjusting for the self-selection, the efficacy among the participants was 28% (0.72, 0.56-0.88). No clear association between the recall rates and the screening efficacy was observed. The organised mammography screening in Finland is effective. The relationship between the estimates of process and outcome of mammography is not yet straightforward: effectiveness and efficacy remain the best estimates for evaluating the success of mammography screening. ' 2007 Wiley-Liss, Inc.Key words: effectiveness; mammography; screening; breast cancer; epidemiology Several randomised trials have reported effectiveness of screening for breast cancer. The combined results showed 25% reduction in breast cancer mortality among women aged 50-69 years at randomisation. 1 The cohort studies on service screening from Sweden and Denmark have reported effects at similar level. [2][3][4] In Finland, a pilot study on breast cancer screening began in 1982. 5 The nationwide mammography programme started in 1987 and it was implemented gradually. The effectiveness for the first 5 years of the programme was analysed using randomised birth cohorts. 6 The study demonstrated a nonsignificant, 24% reduction in breast cancer mortality associated with invitation to screening.The adaptation of results from randomised trials to routine screening is not self-evident. The performance and validity of mammography screening within and between the European programmes have varied widely, 7-9 suggesting differences also in the effectiveness and adverse effects of screening. There has also been variation in the screening policies. 1 The effectiveness of mammography screening has been debated during the last years, 10-12 and the impact of population-based screening on breast cancer mortality has been analysed in many European countries. [2][3][4]6,[13][14][15] The main aim of the current study was to analyse the effectiv...

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Section: Comparison Of Results To Other Studiessupporting

confidence: 61%

Organised mammography screening reduces breast cancer mortality: A cohort study from Finland

Sarkeala

Heinävaara

Anttila

2007

Intl Journal of Cancer

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“…Year 1993 was considered the starting point of breast cancer screening, which was fully implemented in 1996 (Fracheboud et al, 1998(Fracheboud et al, , 2004. Calculation of risk for the ipsilateral and contralateral second breast cancer was performed using only patients with information on laterality of first BCIS and second breast cancer (excluded for this analysis n ¼ 52).…”

Section: Methodsmentioning

confidence: 99%

Increased risk of second malignancies after in situ breast carcinoma in a population-based registry

et al. 2006

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Among 1276 primary breast carcinoma in situ (BCIS) patients diagnosed in 1972 -2002 in the Southern Netherlands, 11% developed a second cancer. Breast carcinoma in situ patients exhibited a two-fold increased risk of second cancer (standardised incidence ratios (SIR): 2.1, 95% confidence interval (CI): 1.7 -2.5). The risk was highest for a second breast cancer (SIR: 3.4, 95% CI: 2.6 -4.3; AER: 66 patients per 10 000 per year) followed by skin cancer (SIR: 1.7, 95% CI: 1.1 -2.6; AER: 17 patients per 10 000 per year). The increased risk of second breast cancer was similar for the ipsilateral (SIR: 1.9, 95% CI: 1.3 -2.7) and contralateral (SIR: 2.0, 95% CI: 1.4 -2.8) breast. Risk of second cancer was independent of age at diagnosis, type of initial therapy, histologic type of BCIS and period of diagnosis. Standardised incidence ratios of second cancer after BCIS (SIR: 2.3, 95% CI: 1.8 -2.8) resembled that after invasive breast cancer (SIR: 2.2, 95% CI: 2.1 -2.4). Surveillance should be directed towards second (ipsi-and contra-lateral) breast cancer.

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“…At the time it was estimated that it would reduce breast cancer mortality in the total female population by 17% (Koning et al, 1995b). Early findings up to 1996 with regard to participation, detection of breast cancers and stage distribution of screen-detected cancers were rather favourable, especially in initial screens (Koning et al, 1995a;Fracheboud et al, 1998). However, the interpretation of the results was hampered by the lack of information on interval cancers.…”

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confidence: 99%

Interval cancers in the Dutch breast cancer screening programme

et al. 1999

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SummaryThe nationwide breast cancer screening programme in The Netherlands for women aged 50-69 started in 1989. In our study we assessed the occurrence and stage distribution of interval cancers in women screened during 1990-1993. Records of 0.84 million screened women were linked to the regional cancer registries yielding a follow-up of at least 2.5 years. Age-adjusted incidence rates and relative (proportionate) incidences per tumour size including ductal carcinoma in-situ were calculated for screen-detected and interval cancers, and cancers in not (yet) screened women, comparing them with published data from the UK regions North West and East Anglia. In total 1527 interval cancers were identified: 0.95 and 0.99 per 1000 woman-years of follow-up in the 2-year interval after initial and subsequent screens respectively. In the first year after initial screening interval cancers amounted to 27% (26% after subsequent screens) of underlying incidence, and in the second year to 52% (55%). Generally, interval cancers had a more favourable tumour size distribution than breast cancer in not (yet) screened women. The Dutch programme detected relatively less (favourable) invasive cancers in initial screens than the UK programme, whereas the number of interval cancers confirms UK findings. Measures should be considered to improve the detection of small invasive cancers and to reduce false-negative rates, even if this will lead to increasing referral rates.

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Nation-wide breast cancer screening in The Netherlands: Results of initial and subsequent screening 1990–1995

Cited by 113 publications

References 17 publications

Organised mammography screening reduces breast cancer mortality: A cohort study from Finland

Organised mammography screening reduces breast cancer mortality: A cohort study from Finland

Increased risk of second malignancies after in situ breast carcinoma in a population-based registry

Interval cancers in the Dutch breast cancer screening programme

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