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Service screening with mammography in Northern Sweden: effects on breast cancer mortality - an update.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.ORCID iD: 0000-0002-5095-3454
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2007 (English)In: Journal of Medical Screening, ISSN 0969-1413, Vol. 14, no 2, 87-93 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study the effectiveness of service screening with mammography in Northern Sweden.

SETTING: Two counties which invited women aged 40-74 years to service screening with mammography were compared with two counties where service screening started 5-7 years later. There were 109,000 and 77,000 women in the study and control counties, respectively.

METHODS: Cohorts in the study group were defined to include only breast cancer cases diagnosed after their first invitation to screening. Two outcome measures for breast cancer mortality were used; excess mortality and underlying cause of death (UCD). Detection mode was used to estimate the efficacy of screening for those women who actually attended screening. The cohorts were followed for 11 years.

RESULTS: The relative rate (RR) of breast cancer death as excess mortality and UCD for women aged 40-74 years invited to screening, compared with women not yet invited, was 0.70 (95% confidence interval [CI] 0.56-0.87) and 0.74 (95% CI 0.62-0.88), respectively. The largest effect was seen in women aged 40-49 years (RR = 0.64 and RR = 0.62 for excess mortality and UCD, respectively). RR in age 40-74 years for women actually screened was 0.65 (95% CI 0.51-0.84) and 0.70 (95% CI 0.57-0.86) for excess mortality and UCD, respectively. The number of women needed to screen to save one life was 912 after 11 years of follow-up.

CONCLUSIONS: This study confirms previous findings in the earlier follow-up and indicates a long-term reduction of breast cancer mortality by 26-30%. The efficacy among those who actually attended screening was about 5% larger.

Place, publisher, year, edition, pages
2007. Vol. 14, no 2, 87-93 p.
National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
URN: urn:nbn:se:umu:diva-16185DOI: 10.1258/096914107781261918PubMedID: 17626708OAI: oai:DiVA.org:umu-16185DiVA: diva2:155858
Available from: 2007-10-04 Created: 2007-10-04 Last updated: 2015-04-29Bibliographically approved
In thesis
1. Evaluation of the effectiveness of mammography screening in Northern Sweden.
Open this publication in new window or tab >>Evaluation of the effectiveness of mammography screening in Northern Sweden.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Service screening with mammography was implemented in Northern Sweden between 1989 and 1998, covering 190,000 women aged 40-74 years constituting the target population in the area.

The aim of this thesis was the evaluation of mammography screening in Northern Sweden with special focus on selected screening performance indicators and on the disease outcome.

We analysed interval cancer (IC) incidence and episode sensitivity in the Norrbotten Mammography Screening Programme (NMSP) for the period 1989-2002. An overall IC rate at 1.1/1000 and IC rate ratio at 38% was found and epsiode sensitivity was estimated at 62-73%, in concert with reference values of the European guidelines.

Radiological classification of the IC cases in three rounds of the NMSP showed that true, occult, missed and minimal signs IC, were present in 48%, 10%, 14% and 28% of the cases.

We analysed early death from breast cancer (n=342) in Northern Sweden during the first five years of mammography service screening. Most fatal cases were advanced and incurable on diagnosis. In a few screen-detected cases with favourable prognostic factors the fatal outcome was unexpected.

We estimated breast cancer survival by detection mode in 5120 women with breast cancer. We found a significantly favourable survival among IC cases compared to cases among uninvited.

We studied breast cancer mortality in relation to mammography screening. Our findings indicated a long-term reduction of breast cancer mortality by 26-30% among women invited to screening and by 31-35% among women screened compared to not screened.

We conclude from our evaluation of the mammography screening in Northern Sweden that women benefited from this public health intervention in form of improved survival and reduced mortality.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2010. 61 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1364
Keyword
mammography, screening, sensitivity, interval cancer, survival, mortality
National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
urn:nbn:se:umu:diva-36141 (URN)978-91-7459-048-7 (ISBN)
Public defence
2010-10-15, Aulan, Sunderby sjukhus, Luleå, 13:00 (Swedish)
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Available from: 2010-09-24 Created: 2010-09-20 Last updated: 2015-04-29Bibliographically approved

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