Breast cancer screening: are we seeing the benefit?

BMC Medicine

Marco Zappa¹  Donella Puliti¹ 

[1] Clinical and Descriptive Epidemiology Unit, ISPO - Cancer Prevention and Research Institute, Via delle Oblate 2, 50141 Florence, Italy

关键词: analysis of trends;    incidence-based mortality studies;    case-control studies;    breast cancer mortality;    Mammography screening;   

Others  :  857350
DOI  :  10.1186/1741-7015-10-106

 received in 2011-10-31, accepted in 2012-09-20,  发布年份 2012

【 摘 要 】

A decline in breast cancer mortality has been observed in western European Countries since the middle of the 1990s.

Different methodological approaches, including case-control studies, incidence-based mortality studies, and trend studies, have been used to assess the effectiveness of mammography screening programmes in reducing breast cancer mortality. However, not all methods succeed in distinguishing the relative contributions of service screening and taking correctly into considerationthe potential source of bias that might affect the estimate.

Recently, a review of six case-control studies confirmed a breast cancer mortality reduction ranging from 38% to 70% among screened women. This figure is in accordance with the estimate obtained from incidence-based mortality studies if screening compliance is taken into account. We will describe the methodological constraints of mortality trend studies in predicting the impact of screening on mortality and the necessary caution that must be applied when interpreting the results of such studies.

In conclusion, when appropriate methodological approaches are used, it is evident that mammographic screening programmes have contributed substantially to the observed decline in breast cancer mortality.

【 授权许可】

   
2012 Puliti and Zappa; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Shapiro S: Screening: assessment of current studies. Cancer 1994, Suppl 1:231-238.
• [2]Vainio H, Bianchini F (Eds): IARC handbook of cancer prevention. Breast cancer screening. Volume 7. Lyon, France: IARC Press; 2002.
• [3]Demissie K, Mills OF, Rhoads GG: Empirical comparison of the results of randomized controlled trials and case-control studies in evaluating the effectiveness of screening mammography. J Clin Epidemiol 1998, 51:81-91.
• [4]von Karsa L, Anttila A, Ronco G, Ponti A, Malila N, Arbyn M, Segnan N, Castillo-Beltran M, Boniol M, Ferlay J, Hery C, Sauvaget C, Voti L, Autier P: Cancer screening in the European Union. Report on the implementation of the Council Recommendation on cancer screening - First Report. Luxembourg: European Commission; 2008.
• [5]Swedish Organised Service Screening Evaluation Group: Reduction in breast cancer mortality from organized service screening with mammography: 1. Further confirmation with extended data. Cancer Epidemiol Biomarkers Prev 2006, 15:45-51.
• [6]Paap E, Verbeek AL, Puliti D, Paci E, Broeders MJ: Breast cancer screening case-control study design: impact on breast cancer mortality. Ann Oncol 2011, 22:863-869.
• [7]Otto SJ, Fracheboud J, Verbeek AL, Boer R, Reijerink-Verheij JC, Otten JD, Broeders MJ, de Koning HJ, for the National Evaluation Team for Breast Cancer Screening: Mammography screening and risk of breast cancer death: a population-based case-control study. Cancer Epidemiol Biomarkers Prev 2012, 21:66-73.
• [8]Paci E, Duffy SW, Giorgi D, Zappa M, Crocetti E, Vezzosi V, Bianchi S, del Turco MR: Quantification of the effect of mammographic screening on fatal breast cancers: The Florence Programme 1990-96. Br J Cancer 2002, 87:65-9.
• [9]Olsen AH, Njor SH, Lynge E: Estimating the benefits of mammography screening: the impact of study design. Epidemiology 2007, 18:487-92.
• [10]Jorgensen KJ, Zahl PH, Gotzsche PC: Breast cancer mortality in organized mammography screening in Denmark: comparative study. BMJ 2010, 340:c241.
• [11]Autier P, Boniol M, Gavin A, Vatten LJ: Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database. BMJ 2011, 343:d4411.
• [12]Gorini G, Zappa M, Miccinesi G, Paci E, Costantini AS: Breast cancer mortality trends in two areas of the province of Florence, Italy, where screening programmes started in the 1970s and 1990s. Br J Cancer 2004, 90:1780-1783.
• [13]Zappa M, Ciatto S: The case control studies. In Evaluation and Monitoring of Screening programmes. Edited by Sankila R, Demaret E, Hakama M, Lynge E, Scouten L, Parkin DM. Brussels-Luxembourg: European Commission, Europe against Cancer Programme; 2000:99-118.
• [14]Sasieni P, Castanon A, Cuzick J: Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ 2009, 339:b2968.
• [15]Allgood PC, Warwick J, Warren RM, Day NE, Duffy SW: A case-control study of the impact of the East Anglian breast screening programme on breast cancer mortality. Br J Cancer 2008, 98:206-209.
• [16]Fielder HM, Warwick J, Brook D, Gower-Thomas K, Cuzick J, Monypenny I, Duffy SW: A case-control study to estimate the impact on breast cancer death of the breast screening programme in Wales. J Med Screen 2004, 11:194-198.
• [17]Gabe R, Tryggvadottir L, Sigfusson BF, Olafsdottir GH, Sigurdsson K, Duffy SW: A case-control study to estimate the impact of the Icelandic population-based mammography screening program on breast cancer death. Acta Radiol 2007, 48:948-55.
• [18]Paap E, Holland R, den Heeten GJ, van Schoor G, Botterweck AA, Verbeek AL, Broeders MJ: A remarkable reduction of breast cancer deaths in screened versus unscreened women: a case-referent study. Cancer Causes Control 2010, 21:1569-1573.
• [19]Puliti D, Miccinesi G, Collina N, De Lisi V, Federico M, Ferretti S, Finarelli AC, Foca F, Mangone L, Naldoni C, Petrella M, Ponti A, Segnan N, Sigona A, Zarcone M, Zorzi M, Zappa M, Paci E, IMPACT Working Group: Effectiveness of service screening: a case-control study to assess breast cancer mortality reduction. Br J Cancer 2008, 99:423-427.
• [20]Roder D, Houssami N, Farshid G, Gill G, Luke C, Downey P, Beckmann K, Iosifidis P, Grieve L, Williamson L: Population screening and intensity of screening are associated with reduced breast cancer mortality: evidence of efficacy of mammography screening in Australia. Breast Cancer Res Treat 2008, 108:409-416.
• [21]Duffy SW, Cuzick J, Tabar L, Vitak B, Hsiu-Hsi Chen T, Yen MF, Smith RA: Correcting for non-compliance bias in case-control studies to evaluate cancer screening programmes. J Royal Stat Soc Series C 2002, 51:235-243.
• [22]Cronin KA, Weed DL, Connor RJ, Prorok PC: Case-control studies of cancer screening: theory and practice. J Natl Cancer Inst 1998, 90:498-504.
• [23]Faggiano F, Partanen T, Kogevinas M, Boffetta P: Socioeconomic differences incancer incidence and mortality. In Socio inequalities and cancer. IARC Scientific Publication No. 138. Edited by Kogevinas M, Pearce N, Susser M, Boffetta P. Lyon: International Agency for Cancer Research; 1997.
• [24]Mackenbach JP: Health inequalities: Europe in profile. [http://ec.europa.eu/health] webciteReport for 'Tackling Health Inequalities Government for Health' London: UK Presidency of EU; 2005.
• [25]Puliti D, Miccinesi G, Zappa M, Manneschi G, Crocetti E, Paci E: Balancing harms and benefits of service mammography screening programs: a cohort study. Breast Cancer Res 2012, 14:R9. BioMed Central Full Text
• [26]Tabár L, Vitak B, Chen HH, Yen MF, Duffy SW, Smith RA: Beyond randomized controlled trials: organized mammographic screening substantially reduces breast carcinoma mortality. Cancer 2001, 91:1724-1731.
• [27]Sarkaela T, Heinävaara S, Anttila A: Organised mammography screening reduces breast cancer mortality: A cohort study from Finland. Int J Cancer 2008, 122:614-619.