umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Evaluation of service screening with mammography in Sweden with special regard to its impact on breast cancer mortality
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2002. , 90 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 792
Keyword [en]
Massundersökningar (medicin), Bröstcancer, Sweden-- epidemiology
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-94113ISBN: 91-7305-250-7 (print)OAI: oai:DiVA.org:umu-94113DiVA: diva2:763340
Public defence
2002-05-17, Tandläkarhögskolan, sal D, 9 tr., Umeå universitet, Umeå, 09:00
Opponent
Projects
digitalisering@umu
Note

Diss. (sammanfattning) Umeå : Umeå universitet, 2002, härtill 6 uppsatser

Available from: 2014-11-14 Created: 2014-10-03 Last updated: 2015-04-09Bibliographically approved
List of papers
1. Excess Mortality from Breast Cancer in Relation to Mammograpy Screening in Northern Sweden
Open this publication in new window or tab >>Excess Mortality from Breast Cancer in Relation to Mammograpy Screening in Northern Sweden
1997 (English)In: Journal of Medical Screening, ISSN 0969-1413, E-ISSN 1475-5793, Vol. 4, no 1, 6-9 p.Article in journal (Refereed) Published
Abstract [en]

Objectives—Previous randomised studies of mammography screening have shown a significant effect on breast cancer mortality, particularly in women aged 50–Q69 at randomisation. Breast cancer mortality has traditionally been studied by judgments on causes of death, either from cause of death registers or from medical records. In this study an alternative method was used, estimating the excess mortality associated with breast cancer.

Setting—In 1990 two counties of northern Sweden started population based mammography screening of women aged 40–74. The unscreened population in the two other counties of the same region were selected as controls.

Results—Excess mortality associated with breast cancer was lower in the screened population, and was discernible three to four years after the start of screening. The relative risk estimate, based on the cumulative excess number of deaths from breast cancer during 1990–95 in the screened versus the control population aged 40–74 (at diagnosis of breast cancer), was 0.72 (95% confidence interval (CI) 0.53 to 0.99). For women aged 50–69 it was 0.67 (95% CI 0.46 to 0.99). In the 50–69 age group the estimated excess number of deaths from breast cancer during 1995 was 17.0 per 100 000 women (95% CI 5.0 to 29.0) in the screened counties and 51.1 per 100 000 (95% CI 30.2 to 71.9) in the unscreened counties.

Conclusions—Population based routine screening has substantial effects on breast cancer mortality in women aged 50–69. Estimation of excess mortality can be used in future studies to evaluate the effects of mammography screening on breast cancer mortality.

Place, publisher, year, edition, pages
Sage Publications, 1997
Keyword
breast cancer, mortality, mammography screening, geographic variation
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-96256 (URN)10.1177/096914139700400104 (DOI)
Projects
digitalisering@umu
Available from: 2014-11-14 Created: 2014-11-14 Last updated: 2017-12-05Bibliographically approved
2. Service Screening with Mammography in Sweden: Evaluation of Effects of Screening on Breast Cancer Mortality in Age Group 40–49 Years
Open this publication in new window or tab >>Service Screening with Mammography in Sweden: Evaluation of Effects of Screening on Breast Cancer Mortality in Age Group 40–49 Years
2000 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 39, no 5, 617-623 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to develop a model for estimating the effect of the nation-wide service screening program with mammography on breast cancer mortality in Sweden. In 1997, the introduction of population-based service screening had been completed in all 26 counties. In approximately half of the counties suitable for evaluation, the lower age limit for invitation was 40 years (study population) and in the other half the age limit was 50 years (control population). The numbers of females aged 40-49 years for the two populations were 202 152 and 237 279, respectively (1988). The study and control populations were compared for the period 1986-1996 with regard to refined breast cancer mortality. To adjust for geographical differences, the period 1976-1986 was used as reference. With a mean follow-up time of 8 years, the estimated relative risk of breast cancer death in relation to invitation to service screening among women aged 40-49 years at breast cancer diagnosis was 0.91 (95% confidence interval 0.72-1.15). These findings were compatible with those presented in the previous overview of the Swedish randomized studies.

Place, publisher, year, edition, pages
Taylor & Francis, 2000
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-96258 (URN)10.1080/028418600750013302 (DOI)
Available from: 2014-11-14 Created: 2014-11-14 Last updated: 2017-12-05Bibliographically approved
3. Service screening with mammography of women aged 50–69 years in Sweden: effects on mortality from breast cancer
Open this publication in new window or tab >>Service screening with mammography of women aged 50–69 years in Sweden: effects on mortality from breast cancer
2001 (English)In: Journal of Medical Screening, ISSN 0969-1413, E-ISSN 1475-5793, Vol. 8, no 3, 152-160 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:To estimate the effect of the population based service screening programme in Sweden on mortality from breast cancer among women aged 50–69. SETTING:In 1986, population based service screening with mammography started in Sweden, and by 1997 screening had been introduced in all counties. Half of the counties invite women from 40 years of age whereas women 50 and older are invited in the other counties. The upper age limit was either 69 or 74. Women in the age group 50–69 years are thus invited to screening in all counties.

METHODS:The counties which started with mammographic screening in 1986–87 constituted the study group and were compared with the counties which started in 1993 or later. In 1987 the mean number of women aged 50–69 was 161 986 and 98 608 in the study and control groups, respectively. Refined excess mortality (smoothed with the Lowess method) from breast cancer and refined cause specific mortality from breast cancer were used as effect measures. To adjust for geographical differences in mortality from breast cancer a reference period was used. Allowance was made for two potential biases: (a) inclusion bias implying the inclusion of cases diagnosed before invitation to screening in the first screening round, and (b) lead time bias.

RESULTS:After a mean follow up time of 10.6 years since the start of screening and a mean individual follow up time of 8.4 years, a non-significant reduction in refined excess mortality for breast cancer was estimated as relative risk (RR) 0.84 (95% confidence interval (95% CI) 0.67 to 1.05). After adjustment for inclusion and lead time biases the RR was 0.80 (20% reduction). Only 27% of the deaths from breast cancer in the total mortality for women aged 50–79 at death consisted of women aged 50–69 at diagnosis who were diagnosed after the start of screening. This figure has important implications for judgement of the impact of screening on age specific national breast cancer mortalities.

CONCLUSIONS:A non-significant reduction in mortality from breast cancer was found in counties performing service screening with mammography in Sweden. Adjustment for possible biases changed the result towards a larger effect of screening. The results do not contradict the effects found in the Swedish randomised mammography trials.

Place, publisher, year, edition, pages
Sage Publications, 2001
Keyword
breast cancer, mortality, mammography screening, evaluation
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-96257 (URN)10.1136/jms.8.3.152 (DOI)
Projects
digitalisering@umu
Available from: 2014-11-14 Created: 2014-11-14 Last updated: 2017-12-05Bibliographically approved
4. Service screening with mammography of women aged 70-74 years in Sweden: effects on breast cancer mortality
Open this publication in new window or tab >>Service screening with mammography of women aged 70-74 years in Sweden: effects on breast cancer mortality
2003 (English)In: Cancer Detection and Prevention, ISSN 0361-090X, E-ISSN 1873-443X, Vol. 27, no 3, 360-369 p.Article in journal (Refereed) Published
Abstract [en]

Since the benefit of mammography screening for women 70 years and older is unclear, the aim of the present study was to evaluate the effect on breast cancer mortality of the population-based service-screening program in Sweden inviting women 70-74 years. Among the counties with service-screening programs in Sweden which started 1986-1990 those with upper age limit 74 years were compared to counties with 69 years as upper age limit with respect to refined breast cancer mortality. Allowance was made for potential biases namely inclusion of cases diagnosed before invitation and lead time. Two methods for estimation of breast cancer mortality were used; underlying cause of death (UCD) and excess mortality. With a mean follow-up of 10.1 years a reduction of the breast cancer excess mortality was estimated at 24%. Using the underlying cause of death the corresponding result was 6%. A non-significant reduction in breast cancer mortality was found in the counties with service-screening program including the age group 70-74 years in Sweden. The estimated reduction was larger when using excess mortality compared to the use of individual underlying cause of death.

Keyword
breast cancer, mortality, mammography screening, evaluation
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-96261 (URN)10.1016/S0361-090X(03)00131-4 (DOI)14585323 (PubMedID)
Projects
digitalisering@umu
Available from: 2014-11-14 Created: 2014-11-14 Last updated: 2017-12-05Bibliographically approved
5. Service screening with mammography: Long-term effects on breast cancer mortality in the county of Gävleborg, Sweden
Open this publication in new window or tab >>Service screening with mammography: Long-term effects on breast cancer mortality in the county of Gävleborg, Sweden
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-96260 (URN)
Projects
digitalisering@umu
Note

Submitted

Available from: 2014-11-14 Created: 2014-11-14 Last updated: 2015-04-29Bibliographically approved
6. Detection of Breast Cancer with Mammography in the First Screening Round in Relation to Expected Incidence in Different Age Groups
Open this publication in new window or tab >>Detection of Breast Cancer with Mammography in the First Screening Round in Relation to Expected Incidence in Different Age Groups
2003 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 42, no 1, 22-29 p.Article in journal (Refereed) Published
Abstract [en]

The ratio (R) of prevalence of screening-detected breast cancer in the first screening round (P) was compared with the expected incidence rate (I) for different age groups in several screening programs. Published data on the first screening round from three Swedish randomized trials and six counties with service screening were used. The women invited to take part in the screening were aged 40/74 years. Not only P and I but also R increased with increasing age. With the youngest age group as reference, the increase was statistically significant for both invasive cancer and invasive cancer and carcinoma in situ together. The studied ratio (R) can be thought of as a measure of efficiency in detecting breast cancer cases in mammography screening. The reasons for the increase are probably that the breast tissue of younger women is denser, which makes the cancer more difficult to detect by mammography, and that slow-growing cancers tend to appear more frequently in older women.

Place, publisher, year, edition, pages
Taylor & Francis, 2003
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-96259 (URN)10.1080/0891060310002195 (DOI)
Available from: 2014-11-14 Created: 2014-11-14 Last updated: 2017-12-05Bibliographically approved

Open Access in DiVA

Evaluation of service screening with mammography in Sweden with special regard to its impact on breast cancer mortality(5234 kB)218 downloads
File information
File name FULLTEXT01.pdfFile size 5234 kBChecksum SHA-512
40178be44e51d79b32bc51a5197f4590384029f1e7a19bfb1b65d6b3f0d4534eac90f9459fec8e1caee5ba62635bf6e10598a16dad606e70172b130abac725f2
Type fulltextMimetype application/pdf

Search in DiVA

By author/editor
Jonsson, Håkan
By organisation
Oncology
Cancer and Oncology

Search outside of DiVA

GoogleGoogle Scholar
Total: 218 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 60 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf