The Edinburgh randomised trial of breast cancer screening: results after 10 years of follow-up

Alexander, Freda E.; Anderson, T. J.; Brown, Helen; Forrest, A. P. M.; Hepburn, W.; Kirkpatrick, A. E.; McDonald, C.; Muir, B. B.; Prescott, R. J.; Shepherd, Susan

doi:10.1038/bjc.1994.342

Cited by 113 publications

(46 citation statements)

References 17 publications

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“…Relative mortality figures from the Edinburgh and New York trials were not available, but it is known that the cases in non-attendees in these trials had survival rates close to those of the cases in the control groups. 13,14 It is therefore likely that the mortality reduction from screening lies somewhere between the uncorrected 38% and the bias-corrected 25%. This is consistent with the randomised trial results and suggests that the Breast Test Wales programme is achieving a similar quality to that of the trials.…”

Section: Discussionmentioning

confidence: 99%

A case-control study to estimate the impact on breast cancer death of the breast screening programme in Wales

Fielder¹,

Warwick

Brook³

et al. 2004

J Med Screen

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Objectives:The aim of this study was to estimate the effect of service screening, as provided by the NHS breast screening programme, on breast cancer mortality in Wales. Furthermore, we wished to ascertain whether a reduction in breast cancer mortality consistent with that observed in the randomised screening trials was being achieved. Setting:The NHS Breast Screening Programme in Wales, managed by Breast Test Wales, with headquarters in Cardiff. Methods:A case-control study design with 1:2 matching. The cases were deaths from breast cancer in women aged 50-75 years at diagnosis who were diagnosed after the instigation of screening in 1991 and who died after 1998. The controls were women who had not died of breast cancer or any other condition during the study period. One was from the same GP practice and the other from a different GP practice within the same district, matched by year of birth.Results: Based on 419 cases, the odds ratio for risk of death from breast cancer for women who have attended at least one routine screen compared to those never screened was 0.62 (95% confidence interval [CI] 0.47-0.82, p=0.001). After excluding cases diagnosed prior to 1995 and adjusting for self-selection bias, the estimated mortality reduction was 25% (odds ratio=0.75, 95% CI 0.49-1.14, p=0.09). Conclusion:The Breast Test Wales screening programme is achieving a reduction in breast cancer mortality of 25% in women attending for screening, which is consistent with the results of the randomized controlled trials of mammographic screening.

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Section: Discussionmentioning

confidence: 99%

A case-control study to estimate the impact on breast cancer death of the breast screening programme in Wales

Fielder¹,

Warwick

Brook³

et al. 2004

J Med Screen

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“…On top of this, for the same cohort, at least another 200 women would go through the possible distress of a false-positive outcome. 16 Of the eight eligible trials in the Gotzsche and Nielsen review 16 (New York 1963, [17][18][19] Malmo 1976 [20][21][22] and Malmo II 1978, 23 Two-County 1977, [24][25][26] Edinburgh 1978, [27][28][29] Canada 1980, [30][31][32][33] Stockholm 1981, [34][35][36][37] Goteborg 1982 38,39 and UK Age Trial 1991 [40][41][42][43][44] ), one was excluded from meta-analysis because the randomisation was seriously flawed and the data held to be unreliable (Edinburgh 1978 28,29 ). Gotzsche and Nielsen 16 found that only three of the remaining trials had adequate randomisation.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the psychological consequences of false-positive screening mammograms

Bond

Pavey²,

Welch³

et al. 2013

Health Technol Assess

142

108

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Reports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Clinical Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.hta.ac.uk/ This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 09/145/01. The contractual start date was in March 2011. The draft report began editorial review in November 2011 and was accepted for publication in June 2012. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. Background: In the UK, women aged 50-73 years are invited for screening by mammography every 3 years. In 2009-10, more than 2.24 million women in this age group in England were invited to take part in the programme, of whom 73% attended a screening clinic. Of these, 64,104 women were recalled for assessment. Of those recalled, 81% did not have breast cancer; these women are described as having a false-positive mammogram.

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“…This would represent a considerable public health benefit, comparable with the reduction in mortality shown by breast and colorectal cancer screening trials. [16][17][18][19] Secondary aims are to document the implementation of the screening programme; to determine its effectiveness in increasing participation in screening and in reducing the incidence of thick melanomas (thicker than 0.75 mm and thicker than 1.5 mm); and to determine the sensitivity, specificity, and costs of screening population for melanoma in the population by primary care physicians.…”

Section: Aims Of the Randomised Trialmentioning

confidence: 99%

A randomised trial of population screening for melanoma

et al. 2002

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Objectives: Melanoma is a significant cause of morbidity and mortality worldwide and incidence is increasing. Survival after treatment is inversely related to the thickness of the tumour at diagnosis. Population screening has the potential to reduce mortality but there is no conclusive evidence of benefit. Such evidence can come best from a randomised trial. Here we describe the design of a community based randomised trial of a population screening programme for melanoma in Queensland, Australia and early results of the first phase of the trial. Methods: A total of 44 communities (aggregate population 560 000 adults aged 30 years or more) will be randomised to receive either a community based screening programme for 3 years or normal practice. The screening programme promotes thorough skin self examination and whole body skin examination by a doctor and provides open access skin cancer screening clinics. In its first phase, the trial is underway in nine intervention and nine control communities. The primary outcome measure is mortality from melanoma during 15 years of follow up. Results: The first phase of the trial has shown the feasibility of implementing a population skin screening programme including regular skin cancer screening clinics, and has shown the strong support of communities and doctors for the programme. There has been a significant 2.5-fold increase in participation in screening in the intervention communities in this first phase after the first 12 months of the trial and no significant increase in participation in screening in control communities during this period. Conclusions: The design of a community based randomised trial of screening for melanoma has been successfully peer reviewed and the intervention has been shown to be feasible in practice. This randomised trial may be one of the last opportunities to develop the evidence required for public health recommendations for population screening for melanoma.

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The Edinburgh randomised trial of breast cancer screening: results after 10 years of follow-up

Abstract: MethodThe tria popukuion Detailed methods have been described previously (Roberts et al., 1984

Cited by 113 publications

References 17 publications

A case-control study to estimate the impact on breast cancer death of the breast screening programme in Wales

A case-control study to estimate the impact on breast cancer death of the breast screening programme in Wales

Systematic review of the psychological consequences of false-positive screening mammograms

A randomised trial of population screening for melanoma

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