Report of the International Workshop on Screening for Breast Cancer

Fletcher, Suzanne W.; Black, William C.; Harris, Russell; Rimer, Barbara K.; Shapiro, Sam

doi:10.1093/jnci/85.20.1644

Cited by 699 publications

(298 citation statements)

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“…Rather, we believe that mammographic screening -proven to be sensitive in women at ages above 50 years (Nystrom et al, 1993) -provides the most plausible explanation (Fletcher et al, 1993) of the recent trends in Sweden. Population-based programmes were introduced in most counties of Sweden from 1987, with 20 of 26 counties included in 1989 and participation rates among invited women averaging 81% in the period 1993-95 (Olsson et al, 1995).…”

Section: Discussionmentioning

confidence: 82%

Recent trends in breast cancer incidence in Sweden

Persson

Bergström²,

Barlow³

et al. 1998

Br J Cancer

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Summary Breast cancer incidence in Sweden during the period shows no clear trend in women aged below 40 years but a transient increase at ages [50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69] years, probably as a result of mammography screening. Our data give no indication that use of oral contraceptives or replacement hormones have affected nationwide breast cancer incidence rates. Keywords: breast cancer; incidence; trends The occurrence of breast cancer has been increasing worldwide in high-incidence Western countries as well as in low-incidence Asian countries (Quinn and Allen, 1995). Both in Scandinavia (Ewertz and Carstensen, 1988;Persson et al, 1993) (Chu et al, 1996). In a previous analysis of nation-based breast cancer incidence rates in Sweden during 1958-88, we found an average annual increase in the agestandardized rates of 1.3% (Persson et al, 1993). Although present in all age groups, this increase was most rapid among younger women. The rate of increase, however, slowed down towards the end of the study period, particularly among the youngest and oldest women. Birth cohort analyses revealed a more than twofold higher risk among women born in the 1940s compared with those born in the 1880s.A recent report from Norway -where there has been little mammographic screening -showed a substantial increase in breast cancer incidence during the period 1983-1993, which was confined to women aged below 50 years (Matheson and Tretli, 1996); the annual increases were 4.0%, 1.1% and 0.5% at ages 0-49, 50-59 and 60-69 years respectively. There was no evident change in the stage distribution over time. Correspondence to: Persson incidence that might be due to the implementation of mammography screening programmes in the late 1980s, to extensive use of combined oral contraceptives (COCs) in young women or to increasing use of hormone-replacement therapy (HRT) among post-menopausal women. SUBJECTS AND METHODSA nationwide cancer registry has operated in Sweden since 1958. In the majority of cases, the registry receives reports on diagnosed cancers from the responsible clinician as well as the pathologist or cytologist. Under-reporting of data to the registry has therefore been low, in the 1970s estimated at 5% (Mattsson and Wallgren, 1984) and in recent years at about 2% (Cancer Registry, 1996). For 98% of the breast cancer cases registered in 1993, the diagnosis was based on a histopathological examination; a similarly high figure was recorded during the last decade. In 1993 no cases were diagnosed at autopsy only (in previous years this figure was less than 0.6%).We based this updated analysis on all 50 022 cases of invasive breast cancer (ICD7 code 170) reported during a 10-year period from 1984 through 1993 (covering the last year with presently available statistics). The chosen period partly overlapped the previous study period and coincided, except for 1 year, with that of the Norwegian investigation (Matheson and Tretli, 1996). Statistical methodsWe analysed the trendwise deve...

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Section: Discussionmentioning

confidence: 82%

Recent trends in breast cancer incidence in Sweden

Persson

Bergström²,

Barlow³

et al. 1998

Br J Cancer

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“…2,3,10 However, limited attention has been given to whether these results apply to African American women. To our knowledge, among the eight randomized clinical trials that have evaluated screening mammography, [11][12][13][14][15][16][17][18][19][20] only the Health Insurance Plan of Greater New York (HIP) Study 11 included a substantial proportion (approximately 20%) of black participants and provided race-specific results.…”

Section: Clinical Trial Datamentioning

confidence: 99%

“…While the results of a number of randomized clinical trials have shown a clear reduction in breast cancer mortality with mammography screening in women over the age of 50 years, the benefit in younger women has been debated. 2,10 However the results of a recent meta-analysis of randomized clinical trials that included women in the 40 -49 years old age group showed significantly lower mortality rates in mammography screened women than in the control groups. 3 In spite of the reduced mortality, a study that evaluated the sensitivity of modern screening mammography by decade of age in a diverse population (36% nonwhite) showed that the sensitivity of mammography to detect invasive breast cancer was still lower among women aged 40-49 years compared with women aged 50 years or older (75% versus 92%).…”

Section: Adequacy Of Current Screening Guidelines For Young African Amentioning

confidence: 99%

Mammography screening in African American women

Jones

Patterson²,

Calvocoressi

2002

Cancer

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“…especiall in youncer women (< 50 Xyears). still remains somew-hat controv-ersial (Fletcher et al 1993: Tabar et al 1995 In the present w-ork. we employed extensive clinical data from large mammogaraphv screening trials that should be representatiVe of the general population.…”

mentioning

confidence: 92%

“…especiall in youncer women (< 50 Xyears). still remains somew-hat controv-ersial (Fletcher et al 1993: Tabar et al 1995: see also Flehinger et al 1993 for lung cancer). As intersal cancer data indicate that not all prevalent tumours are detected by the screening procedure lHolmberg et al.…”

mentioning

confidence: 99%

The growth law of primary breast cancer as inferred from mammography screening trials data

Hart

Shochat²,

Agur³

1998

Br J Cancer

152

111

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Summary Despite considerable progress in understanding tumour development. the law of growth for human tumours is still a matter of some dispute. In this study, we used large-scale mammography screening trial data to deduce the growth law of primary breast cancer. We compared the empirical tumour population size distributions of primary breast cancer inferred from these data to the distributions that correspond to various possible theoretical growth functions. From this. we showed that the data are inconsistent with the exponential, logistic and Gompertz laws, but support power law growth (exponent = 0.5). This law indicates unbounded growth but with slowing mass-specific growth rate and doubling time. In the clinical size ranges, it implies a greater decline in the mass-specific growth rate than would be predicted by the Gompertz law using the accepted parameters. This suggests that large tumours would be less sensitive to cycle-specific therapies. and be better treated first by non-cell cycle-specific agents. We discussed the use of our study to estimate the sensitivity of mammography for the detection of small tumours. For example, we estimated that mammography is about 30% less sensitive in the detection of tumours in the 1 to Flehinger. 1991 and Xu and Prorok. 1997 for theoretical discussions). Nex ertheless. the benefit of screening. especiall in youncer women (< 50 Xyears). still remains somew-hat controv-ersial (Fletcher et al. 1993: Tabar et al. 1995 In the present w-ork. we employed extensive clinical data from large mammogaraphv screening trials that should be representatiVe of the general population. Usinc mathematical tools. we extracted from these data useful information about breast cancer growth.

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Report of the International Workshop on Screening for Breast Cancer

Abstract: Randomized trials have provided stronger scientific evidence regarding the effectiveness of screening for breast cancer than for any other cancer. However, much still needs to be learned. Periodic gatherings of scientists in the field should speed the process.

Cited by 699 publications

References 0 publications

Recent trends in breast cancer incidence in Sweden

Recent trends in breast cancer incidence in Sweden

Mammography screening in African American women

The growth law of primary breast cancer as inferred from mammography screening trials data

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