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Evaluation of the effectiveness of mammography screening in Northern Sweden.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
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 [en]
mammography, screening, sensitivity, interval cancer, survival, mortality
National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
URN: urn:nbn:se:umu:diva-36141ISBN: 978-91-7459-048-7 (print)OAI: oai:DiVA.org:umu-36141DiVA: diva2:352250
Public defence
2010-10-15, Aulan, Sunderby sjukhus, Luleå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-09-24 Created: 2010-09-20 Last updated: 2015-04-29Bibliographically approved
List of papers
1. Interval cancer incidence and episode sensitivity in the Norrbotten mammography screening programme, Sweden
Open this publication in new window or tab >>Interval cancer incidence and episode sensitivity in the Norrbotten mammography screening programme, Sweden
2009 (English)In: Journal of Medical Screening, ISSN 0969-1413, Vol. 16, no 1, 39-45 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To estimate the interval cancer incidence, its determinants and the episode sensitivity in the Norrbotten Mammography Screening Programme (NMSP).

SETTING: Since 1989, women aged 40-74 years (n = 55,000) have been invited to biennial screening by the NMSP, Norrbotten county, Sweden.

METHODS: Data on 1047 invasive breast cancers from six screening rounds of the NMSP (1989-2002) were collected. We estimated the invasive interval cancer rates, rate ratios and the episode sensitivity using the detection and incidence methods. A linear Poisson-model was used to analyse association between interval cancer incidence and sensitivity.

RESULTS: 768 screen-detected and 279 interval cancer cases were identified. The rate ratio of interval cancer decreased with age. The 50-59 year age group showed the highest rate ratio (RR = 0.52, 95% CI 0.41-0.65) and the 70-74 year age group the lowest (RR = 0.23, 95% CI 0.15-0.36). The rate ratios for the early (0-12 months) and late (13-24 months) interval cancers were similar (RR = 0.18, 95% CI 0.15-0.22 and 0.20, 95% CI 0.17-0.24). There was a significantly lower interval cancer incidence in the prevalence round as compared with the incidence rounds. According to the detection method the episode sensitivity increased with age from 57% in the age group 40-49 years to 84% in the age group 70-74 years. The corresponding figures for the incidence method were 50% and 77%, respectively.

CONCLUSION: Our study showed an interval cancer incidence of 38% and the episode sensitivity of 62-73%, depending on the method of calculation. Our results are of clinically acceptable level and concert with the reference values of the European guidelines.

National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
urn:nbn:se:umu:diva-21722 (URN)10.1258/jms.2009.008098 (DOI)19349530 (PubMedID)
Available from: 2009-04-17 Created: 2009-04-17 Last updated: 2015-04-29Bibliographically approved
2. Radiological review of interval cancer in the Norrbotten mammography screening program, Sweden
Open this publication in new window or tab >>Radiological review of interval cancer in the Norrbotten mammography screening program, Sweden
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
urn:nbn:se:umu:diva-35305 (URN)
Available from: 2010-08-12 Created: 2010-08-12 Last updated: 2015-04-29Bibliographically approved
3. Early breast cancer deaths in women aged 40-74 years diagnosed during the first 5 years of organised mammography service screening in north Sweden
Open this publication in new window or tab >>Early breast cancer deaths in women aged 40-74 years diagnosed during the first 5 years of organised mammography service screening in north Sweden
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2004 (English)In: Breast, ISSN 0960-9776, E-ISSN 1532-3080, Vol. 13, no 4, 276-283 p.Article in journal (Refereed) Published
Keyword
Breast cancer deaths, mammography, organised service screening
National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
urn:nbn:se:umu:diva-14999 (URN)10.106/j.breast.2004.04.002 (DOI)15325661 (PubMedID)
Available from: 2007-05-08 Created: 2007-05-08 Last updated: 2015-04-29Bibliographically approved
4. Survival from invasive breast cancer among interval cases in the mammography screening programmes of northern Sweden
Open this publication in new window or tab >>Survival from invasive breast cancer among interval cases in the mammography screening programmes of northern Sweden
2007 (English)In: Breast, ISSN 0960-9776, E-ISSN 1532-3080, Vol. 16, no 1, 47-54 p.Article in journal (Refereed) Published
Keyword
mammography screening, invasive breast cancer, breast cancer survival, interval cases, uninvited cases, detection mode
National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
urn:nbn:se:umu:diva-12232 (URN)10.1016/j.breast/2006.05.006 (DOI)16875820 (PubMedID)
Available from: 2007-08-28 Created: 2007-08-28 Last updated: 2015-04-29Bibliographically approved
5. Service screening with mammography in Northern Sweden: effects on breast cancer mortality - an update.
Open this publication in new window or tab >>Service screening with mammography in Northern Sweden: effects on breast cancer mortality - an update.
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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.

National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
urn:nbn:se:umu:diva-16185 (URN)10.1258/096914107781261918 (DOI)17626708 (PubMedID)
Available from: 2007-10-04 Created: 2007-10-04 Last updated: 2015-04-29Bibliographically approved

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