SCREENING BREAST CANCER

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SCREENINGBREAST CANCER

• Elsebeth Lynge
• Institute of Public Health
• University of Copenhagen
• elsebeth_at_pubhealth.ku.dk

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LODTRÆKNINGSFORSØG
Befolkning
Med given cancer
Ikke med given cancer
Lodtrækning
Screeningsgruppe
Kontrolgruppe
Deltagere
Ikke-deltagere
Screenet udenfor
Ikke screenet
Positiv
Negativ
Positiv
Negativ
Syg
Ikke syg
Syg
Ikke syg
Kontrolgruppe Dødsfald
af sygdom / Personår
Screeningsgruppe Dødsfald af
sygdom / Personår
RRDødelighedsrate i Screeningsgr. /
Dødelighedsrate Kontrolgruppe
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DANISH STUDY

• Screening had existed in Copenhagen for 10
  years Had the routine Copenhagen health care
  system achieved the same results as the
  randomised trials?

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STUDY AND CONTROL GROUPS
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Historical control group
Study group Copenhagen
Age
Age
70
70
BC death
BC death
BC death
BC death
Invitation
Invitation
BC death
BC death
60
60
Invitation
Invitation
Invitation
Invitation
50
50
Time
Time
1991
1989
1979
2001
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METHOD

• Rates for the breast cancer mortality in the
  study group were compared with rates for breast
  cancer mortality in the control groups.
• Poisson regression was used with control for age,
  period and region.
• But NOT controlled for eventual interaction
  between period and region.

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RESULT

• The combined effect of screening and
  interaction between period and region was
• RR 0.75 (95 CI 0.63-0.89)

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INTERACTION BETWEEN PERIOD AND REGION

• Since 1977, the Danish Breast Cancer Cooperative
  Group has organised all diagnostics and treatment
  of breast cancer patients in Denmark.
• All hospital departments have used common
  guidelines for pathology, surgery, radiotherapy
  and systemic treatment.

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INTERACTION BETWEEN PERIOD AND REGION

• Breast cancer patients from the screening region
  received the same treatment as breast cancer
  patients from the control regions.
• Both during the screening period 1991-2001 and
  during the historical control period 1981-1991.

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CONCLUSION

• It has been possible with the mammography
  screening programme in Copenhagen to reduce the
  breast cancer mortality by 25.

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BREAST CANCER INCIDENS
DENMARK WOMEN AGED 50-69
.
Olsen el al, 2003
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CONCLUSION

• Mammography screening has reduced breast cancer
  mortality in RCTs.
• It has also proved to be effective in service
  programmes.
• Mammography screening has both benefits and
  risks.
• Good orgsanisation, quality assurance and
  monitoring needed to maximise benefits.
• Participation should be the womans informed
  choice.