Breast Cancer Screening: Benefits and Harms.

[Argirios Argiriou]

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[Argirios Argiriou]

Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial.

BMJ 2014; 348 doi:

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος (Published 11 February 2014) Cite this as: BMJ 2014;348:g366

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Conclusion: Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available. Overall, 22% (106/484) of screen detected invasive breast cancers were over-diagnosed, representing one over-diagnosed breast cancer for every 424 women who received mammography screening in the trial.

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[Argirios Argiriou]

Και η αντίθετη άποψη:

June 4, 2015,

Breast tests cut death risk by 40%

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Η πρωτότυπη εργασία:

June 3, 2015, NEJM.

Breast-Cancer Screening — Viewpoint of the IARC Working Group.

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[Argirios Argiriou]

July 7, 2015
U.S. Breast Cancer Screening Data Lead to Questions About the Value of Mammography

Thomas L. Schwenk, MD reviewing Harding C et al. JAMA Intern Med 2015 Jul 6. Elmore JG and Etzioni R. JAMA Intern Med 2015 Jul 6.

Higher uptake of mammography is associated with more cancer diagnoses but not with lower cancer-specific mortality.

Despite some trials showing lower breast cancer–related mortality associated with screening mammography, controversy about its benefit persists, because most trials were conducted decades ago, and screening practices and treatments have changed. Researchers used data on 16 million women (age, ≥40) from 547 U.S. counties to identify the percentage who had undergone mammography in 1999 or 2000 (range, 39%–78% across counties). In these same counties, about 53,000 women were diagnosed with breast cancer in 2000 and were followed for at least 10 years.

Significant correlation was noted between the proportion of county residents screened by mammography and the rate of breast cancer diagnoses, with a 10–percentage-point increase in screening associated with a 16% increase in breast cancer diagnoses. Mammography use was associated significantly with the diagnosis rate of both small (≤2 cm) and large (>2 cm) cancers. No association was found between rate of mammography and 10-year breast cancer–associated mortality.

Comment

An ideal screening program should lead to detection of more small cancers and fewer large cancers over time and should be associated with lower cancer-specific mortality. In this study, mammography was associated with a higher rate of small-cancer diagnoses, but also with a higher rate of large-cancer diagnoses and no fewer cancer-specific deaths. Although several explanations for these epidemiological findings are possible, the most compelling is that widespread mammography leads to overdiagnosis of clinically unimportant cancers that have no effect on mortality. According to editorialists, these findings should encourage clinicians who are counseling patients about mammography to be more explicit about overdiagnosis risk.

Editor Disclosures at Time of Publication

    Disclosures for Thomas L. Schwenk, MD at time of publication Editorial boards UpToDate

Citation(s):

    Harding C et al. Breast cancer screening, incidence, and mortality across US counties. JAMA Intern Med 2015 Jul 6; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

    Elmore JG and Etzioni R.Effect of screening mammography on cancer incidence and mortality. JAMA Intern Med 2015 Jul 6; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

- See more at: Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

[Argirios Argiriou]

Int J Cancer. 2015 Nov 12. doi: 10.1002/ijc.29925. [Epub ahead of print]
Impact of Screening Mammography on Breast Cancer Mortality.
Bleyer A1, Baines C2, Miller AB2.
Author information

    1Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.
    2Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.

Abstract

The degree to which observed reductions in breast cancer mortality is attributable to screening mammography has become increasingly controversial. We examined this issue with three fundamentally different approaches: 1) Chronology - the temporal relationship of the onset of breast cancer mortality 1551decline and the national implementation of screening mammography; 2) Magnitude - the degree to which breast cancer mortality declined relative to the amount (penetration) of screening mammography; 3) Analogy - the pattern of mortality rate reductions of other cancers for which population screening is not conducted. Chronology and magnitude were assessed with data from Europe and North America, with three methods applied to magnitude. A comparison of eight countries in Europe and North America does not demonstrate a correlation between the penetration of national screening and either the chronology or magnitude of national breast cancer mortality reduction. In the United States, the magnitude of the mortality decline is greater in the unscreened, younger women than in the screened population and regional variation in the rate of breast cancer mortality reduction is not correlated with screening penetrance, either as self-reported or by the magnitude of screening-induced increase in early-stage disease. Analogy analysis of United States data identifies 14 other cancers with a similar distinct onset of mortality reduction for which screening is not performed. These five lines of evidence from three different approaches and additional observations discussed do not support the hypothesis that mammography screening is a primary reason for the breast cancer mortality reduction in Europe and North America.

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[Argirios Argiriou]

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[Argirios Argiriou]

Critically Assessing Risks and Benefits of Screening Mammography.

Andrew M. Kaunitz, MD Reviewing Welch HG et al., N Engl J Med 2016 Oct 13; 375:1438

Long-term analysis suggests overdiagnosis is more common than early detection and that the bulk of reduced breast cancer mortality in recent decades reflects better treatment.

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[Argirios Argiriou]

22-02-2021

Why I've Changed My Approach to Mammography in Older Women

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[Argirios Argiriou]

Journal Watch,

Marie Claire O'Dwyer, MB BCh BAO, MPH, reviewing Richman IB et al. Ann Intern Med 2023 Aug 8

How Common Is Breast Cancer Overdiagnosis with Screening Mammography in Older Women?

Potentially overdiagnosed breast cancer accounted for about half of screen-detected breast cancers in women 75 or older.

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