Reduction in breast cancer mortality due to the introduction of mass screening in the Netherlands: comparison with the United Kingdom

Abstract

Objective-To assess the impact of the national breast cancer screening programme on breast cancer mortality in the first years after its introduction. Setting-The Netherlands and United Kingdom. Methods-MISCAN models, incorporating demographic, epidemiological, and screening characteristics of the region under study, were used to assess the mortality in the presence and absence of screening. Results-Breast cancer mortality decreased in women aged 55-74 as the Dutch nationwide screening programme built up, and was 5% lower in 1996 than before the start of the programme. The mortality reduction due to screening in the age group 55-74 is expected to increase gradually to 18% in 1999, 10 years after the introduction of screening, and to 29% in the long term. In the United Kingdom screening was expected to achieve a mortality reduction of 5% and 18% in the age group 55-69 five and 10 years respectively after screening was started. A maximum mortality reduction of 24% in this age group is predicted. Conclusions-The eVects of screening will be small in the first years after the start of the programme. Accordingly, it was expected that the reduction in breast cancer mortality due to the Dutch nationwide breast screening programme, which started around 1989, would be statistically significant from 1997 onwards, the point at which the target population of women was completely covered; 70% of the reported 12% mortality reduction in England and Wales in 1994 is expected to be attributed to screening. (J Med Screen 1999;6:30-34)

Prostate cancer mortality reduction by screening: Power and time frame with complete enrollment in the European randomised screening for prostate cancer (ERSPC) trial

“…It has been observed in breast cancer screening that the positive effects of screening do not occur immediately. 16,17 In the first year of prostate cancer screening, direct treatment mortality will have a relatively large negative effect, whereas the positive effects of screening will occur later during the follow-up period. Although it seems more appropriate to use specific mortality reductions for each follow-up year, this assumption does not have a large effect on power.…”

A breast cancer screening programme operating in a liberal health care system: The Luxembourg Mammography Programme, 1992–1997

“…Hence, for participating women, reduction in breast cancer mortality could be at least equivalent to that expected in participating women of same age in The Netherlands, i.e., around 20% for the age group 50 -64. 11 If our hypothesis holds that women were more inclined to attend the Mammography Programme if they already had contact with screening in the past, then the high detection rate at initial screening coupled with tumour size distribution suggests that opportunistic screening was probably not very effective.…”

Cost-effectiveness of different reading and referral strategies in mammography screening in the Netherlands

“…In an experimental setting, 26 screening radiologists read a test set of screening mammograms, consisting of randomly distributed normal and prediagnostic mammograms [6]. We will compare the sensitivity and specificity of the different reading strategies and, by means of a microsimulation model [7], investigate which strategy would be most cost-effective if applied nation-wide.…”