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The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screeningLászló Tabár et al. Cancer. 2019.
. 2019 Feb 15;125(4):515-523. doi: 10.1002/cncr.31840. Epub 2018 Nov 8. Authors László Tabár 1 , Peter B Dean 2 , Tony Hsiu-Hsi Chen 3 , Amy Ming-Fang Yen 4 , Sam Li-Sheng Chen 4 , Jean Ching-Yuan Fann 5 , Sherry Yueh-Hsia Chiu 6 , May Mei-Sheng Ku 3 , Wendy Yi-Ying Wu 7 , Chen-Yang Hsu 3 , Yu-Ching Chen 8 , Kerri Beckmann 9 , Robert A Smith 10 , Stephen W Duffy 11 AffiliationsItem in Clipboard
AbstractBackground: Women and their health care providers need a reliable answer to this important question: If a woman chooses to participate in regular mammography screening, then how much will this choice improve her chances of avoiding a death from breast cancer compared with women who choose not to participate?
Methods: To answer this question, we used comprehensive registries for population, screening history, breast cancer incidence, and disease-specific death data in a defined population in Dalarna County, Sweden. The annual incidence of breast cancer was calculated along with the annual incidence of breast cancers that were fatal within 10 and within 11 to 20 years of diagnosis among women aged 40 to 69 years who either did or did not participate in mammography screening during a 39-year period (1977-2015). For an additional comparison, corresponding data are presented from 19 years of the prescreening period (1958-1976). All patients received stage-specific therapy according to the latest national guidelines, irrespective of the mode of detection.
Results: The benefit for women who chose to participate in an organized breast cancer screening program was a 60% lower risk of dying from breast cancer within 10 years after diagnosis (relative risk, 0.40; 95% confidence interval, 0.34-0.48) and a 47% lower risk of dying from breast cancer within 20 years after diagnosis (relative risk, 0.53; 95% confidence interval, 0.44-0.63) compared with the corresponding risks for nonparticipants.
Conclusions: Although all patients with breast cancer stand to benefit from advances in breast cancer therapy, the current results demonstrate that women who have participated in mammography screening obtain a significantly greater benefit from the therapy available at the time of diagnosis than do those who have not participated.
Keywords: breast cancer; fatality; mammography; mortality; screening.
© 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
Conflict of interest statementDr. Tabár reports personal fees from General Electric Healthcare for preparing automated breast ultrasound teaching cases, and honoraria and travel costs to General Electric Healthcare speaking engagements; personal fees from Mammography Education, Inc. in his capacity as president of the company, which organizes CME courses on breast imaging; and personal fees from Three Palm Software for consultation related to breast imaging interpretation, all outside the submitted work. The other authors made no disclosures.
FiguresFigure 1
Annual population of women ages…
Figure 1
Annual population of women ages 40 to 69 years who did and did…
Figure 1Annual population of women ages 40 to 69 years who did and did not participate in mammography screening (data from statistics of Dalarna County, Sweden, from 1958 to 2015).
Figure 2
The incidence of (A) breast…
Figure 2
The incidence of (A) breast cancer and of (B) breast cancer fatal within…
Figure 2The incidence of (A) breast cancer and of (B) breast cancer fatal within 10 years and (C) breast cancer fatal within 11‐20 years among women who did and did not participate in mammography screening is illustrated. All values indicate 5‐year moving averages for women ages 40 to 69 years (data from statistics of Dalarna County, Sweden, from 1958 to 2015)
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