Updated results of the Gothenburg Trial of Mammographic Screening

Bjurstam, Nils; Björneld, L.; Duffy, Stephen W.

doi:10.1002/cncr.29975

Cited by 29 publications

(28 citation statements)

References 16 publications

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“…On the other hand, the new results of the Gothemburg trial 48 showed a statistically significant protective effect against breast cancer mortality in women under 50 years of age in long-term followup. This result is difficult to explain, precisely in a clinical trial in which there was contamination of approximately 20% of the control group during the intervention period and where more than 50% of the women aged 39 to 49 years had already received at least one mammogram at baseline.…”

Section: Discussionmentioning

confidence: 99%

Diretrizes para detecção precoce do câncer de mama no Brasil. II - Novas recomendações nacionais, principais evidências e controvérsias

et al. 2018

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Breast cancer is the leading cause of cancer mortality in Brazilian women. The new Brazilian guidelines for early detection of breast cancer were drafted on the basis of systematic literature reviews on the possible harms and benefits of various early detection strategies. This article aims to present the recommendations and update the summary of evidence, discussing the main controversies. Breast cancer screening recommendations (in asymptomatic women) were: (i) strong recommendation against mammogram screening in women under 50 years of age; (ii) weak recommendation for mammogram screening in women 50 to 69 years of age; (iii) weak recommendation against mammogram screening in women 70 to 74 years of age; (iv) strong recommendation against mammogram screening in women 75 years or older; (v) strong recommendation that screening in the recommended age brackets should be every two years as opposed to shorter intervals; (vi) weak recommendation against teaching breast self-examination as screening; (vii) absence of recommendation for or against screening with clinical breast examination; and (viii) strong recommendation against screening with magnetic resonance imaging, ultrasonography, thermography, or tomosynthesis alone or as a complement to mammography. The recommendations for early diagnosis of breast cancer (in women with suspicious signs or symptoms) were: (i) weak recommendation for the implementation of awareness-raising strategies for early diagnosis of breast cancer; (ii) weak recommendation for use of selected signs and symptoms in the current guidelines as the criterion for urgent referral to specialized breast diagnosis services; and (iii) weak recommendation that every breast cancer diagnostic workup after the identification of suspicious signs and symptoms in primary care should be done in the same referral center.

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Section: Discussionmentioning

confidence: 99%

Diretrizes para detecção precoce do câncer de mama no Brasil. II - Novas recomendações nacionais, principais evidências e controvérsias

et al. 2018

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“…Our results corroborate the results of most randomized trials, which have shown that screening results in a decrease in the rate of advanced-stage cancer. [1][2][3][4][5] Observational studies have also looked for possible changes in the incidence of advanced-stage cancer after introducing a screening program; although early stage disease tends to have increased in these studies, advanced stage disease has variously been shown to decrease significantly, [20][21][22]37 slightly, 12,18 or not at all. 23,24,38 However, none of these studies has been able to link tumor stage to actual attendance at the individual patient level, and have instead relied on approximations.…”

Section: Discussionmentioning

confidence: 99%

“…Breast cancer screening aims to reduce breast cancer morbidity and mortality by detecting disease at earlier and more treatable stages. Indeed, trials of breast cancer screening have shown that it can reduce the rate of advanced‐stage cancer, and ultimately, reduce the associated mortality . In a meta‐analysis of these randomized trials, the associated relative risk reduction was 20% .…”

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confidence: 99%

“…Indeed, trials of breast cancer screening have shown that it can reduce the rate of advanced-stage cancer, and ultimately, reduce the associated mortality. [1][2][3][4][5] In a meta-analysis of these randomized trials, the associated relative risk reduction was 20%. 6 The strength of these data meant that population-based screening programs were introduced, and subsequent observational studies have confirmed the ability of such programs to reduce mortality.…”

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confidence: 99%

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Is the incidence of advanced‐stage breast cancer affected by whether women attend a steady‐state screening program?

Munck

Fracheboud

Bock

et al. 2018

Intl Journal of Cancer

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In this cross-sectional population-based study, we assessed the incidence of advanced breast cancer based on screening attendance. Women from the Netherlands Cancer Registry were included if aged ≥49 years and diagnosed with breast cancer between 2006 and 2011, and data were linked with the screening program. Cancers were defined as screen-related (diagnosed <24 months after screening) or nonscreened (all other breast cancers). Two cut-offs were used to define advanced breast cancer: TNM-stage (III-IV vs 0-I-II) and T-stage alone (≥15 mm vs <15 mm or DCIS). The incidence rates were adjusted for age and logistic regression was used to compare groups. Of the 72,612 included women diagnosed with breast cancer, 44,246 (61%) had screen-related breast cancer. By TNM stage, advanced cancer was almost three times as likely to be at an advanced TNM stage in the nonscreened group compared with the screen-related group (38 and 94 per 100,000, respectively; OR: 2.86, 95%CI: 2.72-3.00). By T-stage, the incidence of advanced cancer was higher overall, and in nonscreened women was significantly higher than in screened women (210 and 169 per 100,000; OR: 1.85, 95%CI: 1.78-1.93). Data on actual screening attendance showed that the incidence of advanced breast cancer was significantly higher in nonscreened women than in screened women, supporting the expectation that screening would cause a stage shift to early detection. Despite critical evaluations of breast cancer screening programs, our data show that breast cancer screening is a valuable tool that can reduce the disease burden in women.

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“…In order to increase the survival of patients with breast cancer and reduce the aggressiveness of the treatment, the early detection of the disease is extremely important. Meta-analyzes and randomized controlled trials have shown a 20-35% reduction in mortality from breast cancer due to mammographic screening [4][5][6][7]26,27 . Around 8 to 11 deaths from breast cancer will be avoided for every 1,000 women who undergo mammographic screening every two years 7 .…”

Section: Discussionmentioning

confidence: 99%

Trends in breast cancer surgery in private patients under opportunistic screening

Correa¹,

Oenning²,

Martins³

et al. 2019

Mastology

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Objetivo: A pesquisa visa determinar a evolução do estadiamento e do tratamento cirúrgico em pacientes com câncer de mama em uma clínica privada, nos últimos 40 anos. Métodos: Estudo observacional descritivo retrospectivo, por meio da análise estatística dos prontuários de 2105 pacientes atendidas em clínica privada em Curitiba, Paraná, entre 1977 e 2017. Resultados: Dados analisados de 2.105 pacientes diagnosticadas com câncer de mama revelaram que, ao longo do tempo, as cirurgias radicais predominaram quando comparadas às cirurgias conservadoras. No entanto, quando analisadas proporcionalmente ao longo dos anos, é possível constatar uma inversão das modalidades cirúrgicas. Demonstrou-se que de 1977 a 2017, houve aumento de 273% do número das cirurgias conservadoras e queda de 45,5% das mastectomias. Associado a esse dado, notou-se diminuição do número de esvaziamento axilar e consequentemente de linfonodos sentinela positivos. Além disso, os tumores diagnosticados em fase inicial (T1) aumentaram ao longo dos anos. Conclusão: As pacientes tiveram um diagnóstico em estadiamento mais precoce da ABSTRACT Objective: This study aims to determine the evolution of staging and surgical treatment in patients with breast cancer in a private clinic over the last 40 years. Methods: Retrospective descriptive observational study, through statistical analysis of the medical records of 2105 patients treated at a private clinic in Curitiba, Paraná, between 1977 and 2017. Results: Data analyzed from 2,105 patients diagnosed with breast cancer revealed that, over time, radical surgeries predominated when compared to conservative ones. However, when analyzed proportionally over the years, it is possible to observe an inversion of the surgical modalities. It was demonstrated that from 1977 to 2017, there was a 273% increase in the number of conservative surgeries and a 45.5% decrease in mastectomies. In addition to this data, there was a decrease in the number of axillary emptying and, consequently, of positive sentinel lymph nodes. In addition, tumors diagnosed early (T1) have increased over the years. Conclusion: Patients had an early diagnosis of the disease, resulting in less invasive surgical treatments and, consequently, lower morbidity and mortality.

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Updated results of the Gothenburg Trial of Mammographic Screening

Cited by 29 publications

References 16 publications

Diretrizes para detecção precoce do câncer de mama no Brasil. II - Novas recomendações nacionais, principais evidências e controvérsias

Diretrizes para detecção precoce do câncer de mama no Brasil. II - Novas recomendações nacionais, principais evidências e controvérsias

Is the incidence of advanced‐stage breast cancer affected by whether women attend a steady‐state screening program?

Trends in breast cancer surgery in private patients under opportunistic screening

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