The online version of this article (https://doi.org/10.1186/s12885-018-4666-1) contains supplementary material, which is available to authorized users.
Observational studies have reported conflicting results on the impact of mammography service screening programmes on the advanced breast cancer rate (ABCR), a correlation that was firmly established in randomized controlled trials. We reviewed and summarized studies of the effect of service screening programmes in the European Union on ABCR and discussed their limitations.
The PubMed database was searched for English language studies published between 01-01-2000 and 01–06-2018. After inspection of titles and abstracts, 220 of the 8644 potentially eligible papers were considered relevant. Their abstracts were reviewed by groups of two authors using predefined criteria. Fifty studies were selected for full paper review, and 22 of these were eligible. A theoretical framework for their review was developed. Review was performed using a ten-point checklist of the methodological caveats in the analysis of studies of ABCR and a standardised assessment form designed to extract quantitative and qualitative information.
Most of the evaluable studies support a reduction in ABCR following the introduction of screening. However, all studies were challenged by issues of design and analysis which could at least potentially cause bias, and showed considerable variation in the estimated effect. Problems were observed in duration of follow-up time, availability of reliable reference ABCR, definition of advanced stage, temporal variation in the proportion of unknown-stage cancers, and statistical approach.
We conclude that much of the current controversy on the impact of service screening programmes on ABCR is due to observational data that were gathered and/or analysed with methodological approaches which could not capture stage effects in full. Future research on this important early indicator of screening effectiveness should focus on establishing consensus in the correct methodology.
Autier P, Héry C, Haukka J, Boniol M, Byrnes G. Advanced breast cancer and breast cancer mortality in randomized controlled trials on mammography screening. J Clin Oncol. 2009;27:5915–23. CrossRef
Tabar L, Fagerberg G, Duffy SW, Day NE, Gad A, Grontoft O. Update of the Swedish two-county program of mammographic screening for breast cancer. Radiol Clin N Am. 1992;30:187–210. PubMed
UICC. TNM classification of malignant tumours. 7th ed. New York: Wiley-Blackwell; 2009.
Anttila A, Läärä E. Cervix cancer: geographical correlations. In: Sankila R, Démaret E, Hakama M, Lynge E, Schouten LJ, Parkin DM, editors. Evaluation and monitoring of screening programmes. Luxembourg: Office for Official Publications of the European Communities; 2001. p. 77–98.
Swedish Organised Service Screening Evaluation Group. Effect of mammographic service screening on stage at presentation of breast cancers in Sweden. Cancer. 2007;109:2205–12. CrossRef
Lousdal ML, Kristiansen IS, Møller B, Støvring H. Trends in breast cancer stage distribution before, during and after introduction of a screening programme in Norway. Eur J Pub Health. 2014;24:1017–22. CrossRef
Fracheboud J, De Gelder R, Otto SJ, Van Ineveld BM, Otten JDM, Broeders MJM, et al. National evaluation of breast cancer screening in the Netherlands. In: Twelfth evaluation report (in Dutch). XII. Rotterdam: Dept of Public Health, Erasmus University Rotterdam; 1990-2007. p. 2009.
Swedish Organised Service Screening Evaluation Group. Reduction in breast cancer mortality from organized service screening with mammography: 1. Further confirmation with extended data. Cancer Epidemiol Biomarkers Prev. 2006;15:45–51. CrossRef
Broeders M, Nyström L, Ascunce N, Riza E, Becker N, Törnberg S, et al. Epidemiological guidelines for quality assurance in breast cancer screening. In: Perry N, Broeders M, de Wolf C, Törnberg S, Holland R, von Karsa L, editors. European guidelines for quality assurance in breast cancer screening and diagnosis. Luxembourg: Office for Official Publications of the European Communities; 2006. p. 15–56.
- The impact of mammography screening programmes on incidence of advanced breast cancer in Europe: a literature review
M. J. M. Broeders
S. W. Duffy
I. D. Nagtegaal
S. M. Moss
- BioMed Central
Neu im Fachgebiet Onkologie
Mail Icon II