Update of the Swedish Two-County Trial of Breast Cancer Screening: Histologic Grade-Specific and Age-Specific Results

Swiss Surgery ◽  
1999 ◽  
Vol 5 (5) ◽  
pp. 199-204 ◽  
Author(s):  
Tabar ◽  
Vitak ◽  
Chen ◽  
Prevost ◽  
Duffy
Keyword(s):  
Breast Cancer ◽  
Markov Chain ◽  
Breast Cancer Mortality ◽  
Mammographic Screening ◽  
Histologic Grade ◽  
Mortality Benefit ◽  
Markov Chain Models ◽  
Study Population ◽  
Grade Iii

The benefit of mammographic screening in reducing mortality from breast cancer is well established. Questions remain with respect to the magnitude of the long-term benefit of modern mammography screening, age specific benefits and the timing of these, and histology-specific effects. Methods. The Swedish Two-County Trial was set up in 1977, with 77080 women aged 40-74 randomised to invitation to mammographic screening for breast cancer (active study population, ASP) and 55985 women randomised to no invitation (passive study population, PSP). There is now follow-up for mortality to 31 December 1996, approximately 18 years average follow-up. We investigated the effect of invitation of screening on breast cancer mortality and incidence of advanced tumours by age group (40-49 and 50-74) and histologic type. In addition we estimated progression rates by histologic grade using markov chain models. Results. A significant 29% reduction in breast cancer mortality was observed in association with invitation to screening (relative risk = 0.71, 95% confidence interval 0.60-0.83), maintaining the effect observed at previous stages of follow-up. Age-specific analyses show a smaller and later mortality benefit in women aged 40-49. This is related to the fact that there is a considerable benefit from early detection in terms of mortality from aggressive, poorly differentiated cancers in women aged 50-74, whereas the major effect in women aged 40-49 is on the less aggressive tumours of good or intermediate differentiation. Among women aged 50-74, the incidence of grade III tumours in the ASP is significantly lower than in the PSP, but this is not the case for women aged 40-49. This is related to the greater prevalence and rapidity of progression with respect to histologic grade, as evidenced by the results of markov chain models and the proportions of grade III tumours by time since last screen. Conclusions. The substantial and significant mortality benefit of invitation to mammographic screening in women aged 40-74 is maintained at 18 years of follow-up. To achieve a substantial mortality benefit at an early stage in the screening program in women aged under 50 years, an interscreening interval of 12-18 months would be required.

Examining the impact of frequent versus infrequent screenings for breast cancer on employer costs.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16550-e16550
Author(s):  
Kavita V. Nair ◽  
Vahram Ghushchyan ◽  
Lisa A Thompson ◽  
Cindy L. O'Bryant ◽  
Richard Read Allen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Chronic Condition ◽  
Linear Models ◽  
Breast Cancer Mortality ◽  
Condition Index ◽  
Baseline Period ◽  
Mammographic Screening ◽  
Index Number ◽  
The Impact

e16550 Background: Studies have shown an effective way to reduce breast cancer mortality is through early detection with periodic mammographic screening. Screening can increase the likelihood that cancer is detected at an earlier stage when treatment can be more effective and less expensively. Employers may be motivated to improve screening efforts if it results in improved survival and lower healthcare costs. We estimated differences in breast cancer and all cause related costs for women between 40-65 years who received regular screenings compared to those who did not. Methods: Data obtained from the LifeLink™ Health Plan Claims Database (2000 – 2010). ICD-9 codes (174.xx and 233.xx) were used to identify women between 40-65 with a diagnosis for breast cancer, who had an mammogram in the 6 months prior to diagnosis (baseline period) and had a minimum of 12 months following the diagnosis. Two cohorts were created. Those with at least one additional mammogram in the 12 months prior to the start of the baseline period (frequent mammogram group) and those with no additional mammograms (infrequent group). Both groups were followed for a minimum of 12 months and a maximum of 10 years. Adjusted differences in breast cancer and all cause costs were examined controlling for age, chronic condition index, number of mammograms in the baseline period, region and years of follow up using generalized linear models. Results: Mean age was 54 in the frequent (n=1582) and 56 in the infrequent (n=1379) group. Infrequent group had 29.7% of women between 40-49 years compared to 23.6% in the frequent group. Majority of the frequent group (85%) had one additional mammogram in the 12 months preceding the baseline period while 15% had > 2 mammograms. Infrequent group incurred on average $5715 higher breast cancer costs in year one compared to the frequent group (p <0.001). All cause costs in year one were also $6222 higher in the infrequent group (p<0.001). Similar trends were seen in years 2-5 for breast cancer and years 2-3 for all cause costs. Differences were consistent for each year of age from 40-65. Conclusions: Our findings suggest that efforts to improve screening rates can affect employer costs for treating breast cancer between 1-5 years following diagnosis.

scholarly journals Mammography Screening: Keeping Women Alive

2011 ◽  
Vol 7 (6) ◽  
pp. 631-633 ◽  
Author(s):  
André LM Verbeek
Keyword(s):  
Breast Cancer ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Interval Cancer ◽  
Positive Outcome ◽  
Mammographic Screening ◽  
Breast Cancer Death ◽  
Human Cost ◽  
The Uk

Evaluation of: Tabár L, Vitak B, Chen TH et al. Swedish Two-County Trial: impact of mammographic screening on breast cancer mortality during 3 decades. Radiology 260(3), 658–663 (2011). In the 1980s, the periodic invitation of women aged 40–69 years for mammographic screening in the Swedish Two-County Trial showed a strong 30% reduction in breast cancer mortality. The result of 2–3-yearly mammographic examinations has persisted throughout the long follow-up of three decades. Through the richness of the collected and verified data, the trial has also demonstrated a substantial and absolute reduction in mortality risk. For each 414 women screened for 7 years (approximately four screening examinations), one breast cancer death was prevented. Transferring these outcomes to, for example, the national program of the UK, for every 1000 women aged 47–73 years attending the 3-yearly screenings (nine screening examinations) at least five to seven breast cancer deaths would be prevented. In recent follow-up papers by the Swedish trial group, the major human cost of screening (false-positive outcome, occurrence of interval cancer, overdiagnosis and radiation exposure) were judged to be in balance with the accurately demonstrated mortality benefit.

scholarly journals Women’s conceptual knowledge about breast cancer screening and overdiagnosis in Norway: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052121
Author(s):  
Kaitlyn M Tsuruda ◽  
Marit B Veierød ◽  
Nehmat Houssami ◽  
Gunvor G Waade ◽  
Gunhild Mangerud ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Mortality ◽  
False Positive ◽  
Conceptual Knowledge ◽  
Breast Cancer Mortality ◽  
Mammographic Screening ◽  
Mortality Benefit ◽  
Cross Sectional ◽  
The Mean ◽  
Positive Results

ObjectiveTo investigate conceptual knowledge about mammographic screening among Norwegian women.DesignWe administered a cross-sectional, web-based survey. We used multiple-choice questions and a grading rubric published by a research group from Australia.SettingOur Norwegian-language survey was open from April to June 2020 and targeted women aged 45–74 years.Participants2033 women completed our questionnaire. We excluded 13 women outside the target age range and 128 women with incomplete data. Responses from 1892 women were included in the final study sample.Primary and secondary outcome measuresThe questionnaire focused on women’s knowledge about the breast cancer mortality reduction, false positive results and overdiagnosis associated with mammographic screening. The primary outcome was the mean number of marks assigned in each of the three themes and overall. There were three potential marks for questions about breast cancer mortality, one for false positives and six for overdiagnosis.ResultsMost women (91.7%) correctly reported that screened women are less likely to die of breast cancer than non-screened women. 39.7% of women reported having heard of a ‘false positive screening result’ and 86.2% identified the term’s definition; 51.3% of women had heard of ‘overdiagnosis’ and 14.8% identified the term’s definition. The mean score was 2.59 of 3 for questions about breast cancer mortality benefit and 0.93 of 1 for the question about false positive screening results. It was 2.23 of 6 for questions about overdiagnosis.ConclusionsMost participants correctly answered questions about the breast cancer mortality benefit and false positive results associated with screening. The proportion of correct responses to questions about overdiagnosis was modest, indicating that conceptual knowledge about overdiagnosis was lower. Qualitative studies that can obtain in-depth information about women’s understanding of overdiagnosis may help improve Norwegian-language information about this challenging topic.

Mammography Surveillance and Mortality in Older Breast Cancer Survivors

2007 ◽  
Vol 25 (21) ◽  
pp. 3001-3006 ◽  
Author(s):  
Timothy L. Lash ◽  
Matthew P. Fox ◽  
Diana S.M. Buist ◽  
Feifei Wei ◽  
Terry S. Field ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Cancer Mortality ◽  
Breast Cancer Survivors ◽  
Care Delivery ◽  
Breast Cancer Mortality ◽  
The United States ◽  
Stage I ◽  
Early Stage Disease

Purpose There are more than 2,000,000 breast cancer survivors in the United States today. While surveillance for asymptomatic recurrence and second primary is included in consensus recommendations, the effectiveness of this surveillance has not been well characterized. Our purpose is to estimate the effectiveness of surveillance mammography in a cohort of breast cancer survivors with complete ascertainment of surveillance mammograms and negligible losses to follow-up. Patients and Methods We enrolled 1,846 stage I and II breast cancer patients who were at least 65 years old at six integrated health care delivery systems. We used medical record review and existing databases to ascertain patient, tumor, and therapy characteristics, as well as receipt of surveillance mammograms. We linked personal identifiers to the National Death Index to ascertain date and cause of death. We matched four controls to each breast cancer decedent to estimate the association between receipt of surveillance mammogram and breast cancer mortality. Results One hundred seventy-eight women died of breast cancer during 5 years of follow-up. Each additional surveillance mammogram was associated with a 0.69-fold decrease in the odds of breast cancer mortality (95% CI, 0.52 to 0.92). The protective association was strongest among women with stage I disease, those who received mastectomy, and those in the oldest age group. Conclusion Given existing recommendations for post-therapy surveillance, trials to compare surveillance with no surveillance are unlikely. This large observational study provides support for the recommendations, suggesting that receipt of surveillance mammograms reduces the rate of breast cancer mortality in older patients diagnosed with early-stage disease.

Mode of detection and breast cancer mortality by follow-up time and tumor characteristics among screened women in Cancer Prevention Study-II

2019 ◽  
Vol 177 (3) ◽  
pp. 679-689 ◽  
Author(s):  
Samantha Puvanesarajah ◽  
Susan M. Gapstur ◽  
Alpa V. Patel ◽  
Mark E. Sherman ◽  
W. Dana Flanders ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Prevention ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Tumor Characteristics ◽  
Prevention Study ◽  
Mode Of Detection

scholarly journals The relative effect of mammographic screening on breast cancer mortality by socioeconomic status

Medicine ◽  
2016 ◽  
Vol 95 (31) ◽  
pp. e4335 ◽  
Author(s):  
Theodora M. Ripping ◽  
Danielle van der Waal ◽  
André L.M. Verbeek ◽  
Mireille J.M. Broeders
Keyword(s):  
Breast Cancer ◽  
Socioeconomic Status ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Mammographic Screening ◽  
Relative Effect

scholarly journals Application of a domicile-based exercise program for shoulder rehabilitation after breast cancer surgery

2012 ◽  
Vol 20 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Eliana Louzada Petito ◽  
Afonso Celso Pinto Nazário ◽  
Simone Elias Martinelli ◽  
Gil Facina ◽  
Maria Gaby Rivero De Gutiérrez
Keyword(s):  
Breast Cancer ◽  
Experimental Study ◽  
Cancer Patients ◽  
Preoperative Evaluation ◽  
Exercise Program ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Quasi Experimental ◽  
Study Population

The aim of this study was to evaluate the effectiveness of an exercise program for the recuperation of the range of motion (ROM) of the shoulder. This is a quasi-experimental study developed at the Mastology Outpatient Clinic of the Federal University of São Paulo - Brazil, from August 2006 to June 2008, with 64 breast cancer patients undergoing surgery. The intervention consisted of: preoperative evaluation of the ROM, verbal and written guidance, demonstration and implementation of the exercises and revaluation at the outpatient follow-up appointments until the 105th postoperative day (PO). From the 7th PO a significant increase was observed in the ROM, which continued until the 105th PO. The minimum time for recovery was 105 days for the women undergoing mastectomy, and 75 days for those undergoing quadrantectomy. There was satisfactory adherence of 78.6% of the women. The domicile program was effective for the recovery of ROM in the study population, benefiting women who can not attend a presential program.

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