nach oben

Journal of Public Health

Erschienen in:

01.02.2010 | Original Article

Spontaneous remissions in breast cancer underline the need of more evidence: screening should not detect more cancer but earlier cancer

verfasst von: Franz Porzsolt, Dieter Hölzel

Erschienen in: Journal of Public Health | Ausgabe 1/2010

Einloggen, um Zugang zu erhalten

Abstract

Aim

Analysis of the hypothesis that 22% of breast cancer cases detected by screening mammography would disappear spontaneously.

Methods

Critical appraisal of the relevant scientific literature using established methods.

Results

The hypothesis—although it is unusual—seems to be very well supported by data from several independent research groups and justifies three lessons.

Conclusions

First, it is necessary to complete the last step of the concept of traditional evidence-based medicine (EBM), i.e., to confirm that the outcome that is predicted by scientific evidence will also be observed in daily clinical practice. Second, the focus of medical teaching should be directed to final clinical outcomes and patient benefit rather than surrogate parameters, such as completed procedures or test results. Third, the availability of data to answer unsolved questions may become a more important indicator for high-quality health-care systems than the performance of services of unknown incremental value.

Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Clarke M, Coates AS, Darby SC, Davies C, Gelber RD, Godwin J, Goldhirsch A, Gray R, Peto R, Pritchard KI, Wood WC (2008) Adjuvant chemotherapy in oestrogen-receptor-poor breast cancer: patient-level meta-analysis of randomised trials. Lancet 371:29–40CrossRefPubMed

Ghosh K, Brandt KR, Sellers TA, Reynolds C, Scott CG, Maloney SD, Carston MJ, Pankratz VS, Vachon CM (2008) Association of mammographic density with the pathology of subsequent breast cancer among postmenopausal women. Cancer Epidemiol Biomarkers Prev 17:872–879CrossRefPubMed

Gøtzsche PC, Nielsen M (2006) Screening for breast cancer with mammography. Cochrane Database Syst Rev (4):CD001877. Review

Harbeck N, Nimmrich I, Hartmann A, Ross JS, Cufer T, Grützmann R, Kristiansen G, Paradiso A, Hartmann O, Margossian A, Martens J, Schwope I, Lukas A, Müller V, Milde-Langosch K, Nährig J, Foekens J, Maier S, Schmitt M, Lesche R (2008) Multicenter study using paraffin-embedded tumor tissue testing PITX2 DNA methylation as a marker for outcome prediction in tamoxifen-treated, node-negative breast cancer patients. J Clin Oncol Aug 18. [Epub ahead of print]

Hay J (1999) Health care costs and outcomes: How should we evaluate real world data Value in Health 2: 417–419

Hölzel D, Altwein J (1991) Hodentumoren: Ist der Rückgang der Mortalität in der Bundesrepublik Deutschland zu langsam erfolgt? Dtsch Arztebl 88:4123

Japan Finance Cooperation and Japan Bank of International Cooperation (2003) Summary of Objection Procedures Based on Guidelines for Confirmation of Environmental and Social Considerations. http://www.jbic.go.jp/en/about/environment/guideline/disagree/index.html

Jonsson H, Johansson R, Lenner P (2005) Increased incidence of invasive breast cancer after the introduction of service screening with mammography in Sweden. Int J Cancer 117:842–847CrossRefPubMed

Jonsson H, Bordás P, Wallin H, Nyström L, Lenner P (2007) Service screening with mammography in Northern Sweden: effects on breast cancer mortality—an update. J Med Screen 14:87–93CrossRefPubMed

Kaplan RM, Porzsolt F (2008) The natural history of breast cancer. Arch Intern Med 168:2302–2303CrossRefPubMed

Miller AB, Baines CJ, To T, Wall C (1992) Canadian National Breast Screening Study 2. Breast cancer detection and death rates among women aged 50 to 59 years. CMAJ 147:1477–1488PubMed

Miller AB, To T, Baines CJ, Wall C (2000) National Breast Screening Study-2: 13-year results of a randomized trial in women aged 50–59 years. J Natl Cancer Inst 92:1490–1499CrossRefPubMed

Miller AB, To T, Baines CJ, Wall C (2002) The Canadian National Breast Screening Study-1: breast cancer mortality after 11 to 16 years of follow-up. A randomized screening trial of mammography in women age 40 to 49 years. Ann Intern Med 137:305–312PubMed

Perry N, Broeders M, deWolf C, Törnberg S, Holland R, von Karsa L (2006) European guidelines for quality assurance in breast cancer screening and diagnosis. 4th edition. European Communities 2006. ISBN 92-79-01258-4

Porzsolt F (2009) Der natürliche Verlauf des Mammkarzinoms. Dtsch Med Wochenschr 134:238

Porzsolt F, Kaplan RM (2006) “CLINECS”—Strategy and tactics to provide evidence of the usefulness of health care services from the patient’s standpoint (value for patients). In: Porzsolt F, Kaplan RM (eds) Optimizing health—improving the value of health care delivery. Springer, New YorkCrossRef

Porzsolt F, Kilian R (2006) Klinische Forschung, Ergebnisforschung, Versorgungsforschung. Gesundh ökon Qual manag 11:311–318CrossRef

Porzsolt F, Ohletz A, Thim A, Gardner D, Ruatti H, Meier H, Schlotz-Gorton N, Schrott L (2003a) Evidence-based decision making. The six step approach. Editorial. ACP-Journal Club 139:A10

Porzsolt F, Ohletz A, Thim A, Gardner D, Ruatti H, Meier H, Schlotz-Gorton N, Schrott L (2003b) Evidence-based decision making. The six step approach. Editorial. Evidence-Based Medicine 8:165–166CrossRef

Porzsolt F, Stengel D, Ghosh A (2005) Ergebnisforschung: Nutzen für Patienten muss nachgewiesen werden. Deutsches Ärzteblatt 102:2380–2385

Porzsolt F, Leonhardt-Huober H, Kaplan RM (2006a) Aims and value of screening: is perceived safety a value for which to pay? In: Porzsolt F, Kaplan RM (eds) Optimizing health—improving the value of healthcare delivery. Springer, New York, pp 199–204CrossRef

Porzsolt F, Stengel D, Ghosh AK, Kaplan RM (2006b) Clinical research and outcomes research: Common criteria and differences. In: Porzsolt F, Kaplan RM (eds) Optimizing health—improving the value of healthcare delivery. Springer, New York, pp 257–264

Sackett DL, Straus SE, Richardson WS et al (2004) Evidence-based medicine. How to practice and teach EBM, 2nd ed., Churchill Livingstone, Edinburgh

Schwartz LM, Woloshin S, Fowler FJ Jr, Welch HG (2004) Enthusiasm for cancer screening in the United States. JAMA 291:71–78CrossRefPubMed

van de Vijver MJ et al (2002) A gene-expression signature as a predictor of survival in breast cancer. N Engl J Med 347:1999–2009CrossRefPubMed

Zackrisson S, Andersson I, Janzon L, Manjer J, Garne JP (2006) Rate of over-diagnosis of breast cancer 15 years after end of Malmö mammographic screening trial: follow-up study. BMJ 332:689–692CrossRefPubMed

Zahl PH, Mæhlen J (2006) Do model results suggest spontaneous regression of breast cancer? Int J Cancer 118:2647CrossRefPubMed

Zahl PH, Andersen JM, Mæhlen J (2004a) Spontaneous regression of cancerous tumors detected by mammography screening. JAMA 292:2579–2580CrossRefPubMed

Zahl PH, Strand BH, Mæhlen J (2004b) Incidence of breast cancer in Norway and Sweden during introduction of nationwide screening: prospective cohort study. BMJ 328:921–924CrossRefPubMed

Zahl PH, Gøtzsche PC, Andersen JM, Mæhlen J (2006a) WITHDRAWN: Results of the Two-County Trial of mammography screening are not compatible with contemporaneous official Swedish breast cancer statistics. Eur J Cancer Mar 9. [Epub ahead of print]

Zahl PH, Gøtzsche PC, Andersen JM, Maehlen J (2006b) Results of the Two-County trial of mammography screening are not compatible with contemporaneous official Swedish breast cancer statistics. Dan Med Bull 53:438–440PubMed

Zahl PH, Mæhlen J, Welch HG (2008) The natural course of invasive breast cancer detected by mammography. Arch Intern Med 168:2311–2316CrossRefPubMed

Titel: Spontaneous remissions in breast cancer underline the need of more evidence: screening should not detect more cancer but earlier cancer
verfasst von: Franz Porzsolt
Dieter Hölzel
Publikationsdatum: 01.02.2010
Verlag: Springer-Verlag
Erschienen in: Journal of Public Health / Ausgabe 1/2010
Print ISSN: 2198-1833
Elektronische ISSN: 1613-2238
DOI: https://doi.org/10.1007/s10389-009-0275-4

Springer Medizin

Abstract

Aim

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2010

Vivienne Harpwood, Medicine, Malpractice and Misapprehensions

Editorial

Racial differences in smoking abstinence rates in a multicenter, randomized, open-label trial in the United States

Factors contributing to customer satisfaction with community pharmacies in Malaysia

Influencing public health policy: to what extent can public action defining the policy concerns of government?

Postgraduate medical training and migration in Europe: a survey of financial and labour conditions