Effect of screening and adjuvant therapy on mortality from breast cancer.

BACKGROUND We used modeling techniques to assess the relative and absolute contributions of screening mammography and adjuvant treatment to the reduction in breast-cancer mortality in the United States from 1975 to 2000. METHODS A consortium of investigators developed seven independent statistical models of breast-cancer incidence and mortality. All seven groups used the same sources to obtain data on the use of screening mammography, adjuvant treatment, and benefits of treatment with respect to the rate of death from breast cancer. RESULTS The proportion of the total reduction in the rate of death from breast cancer attributed to screening varied in the seven models from 28 to 65 percent (median, 46 percent), with adjuvant treatment contributing the rest. The variability across models in the absolute contribution of screening was larger than it was for treatment, reflecting the greater uncertainty associated with estimating the benefit of screening. CONCLUSIONS Seven statistical models showed that both screening mammography and treatment have helped reduce the rate of death from breast cancer in the United States.

[1]  A. Leitch,et al.  American Cancer Society guidelines for the early detection of breast cancer: Update 1997 , 1997, CA: a cancer journal for clinicians.

[2]  K. Kerlikowske,et al.  Breast Cancer Surveillance Consortium: a national mammography screening and outcomes database. , 1997, AJR. American journal of roentgenology.

[3]  Mike Clarke,et al.  Tamoxifen for early breast cancer: an overview of the randomised trials , 1998, The Lancet.

[4]  Mike Clarke,et al.  Polychemotherapy for early breast cancer: an overview of the randomised trials , 1998, The Lancet.

[5]  F. Alexander,et al.  The natural history of breast carcinoma , 2000, Cancer.

[6]  A. Miller,et al.  Canadian National Breast Screening Study-2: 13-year results of a randomized trial in women aged 50-59 years. , 2000, Journal of the National Cancer Institute.

[7]  L. Tabár,et al.  The Swedish Two-County Trial twenty years later. Updated mortality results and new insights from long-term follow-up. , 2000, Radiologic clinics of North America.

[8]  D K Wagener,et al.  Progress in cancer screening over a decade: results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. , 2001, Journal of the National Cancer Institute.

[9]  Peter C Gøtzsche,et al.  Cochrane review on screening for breast cancer with mammography , 2001, The Lancet.

[10]  T. To,et al.  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 , 2002, Annals of Internal Medicine.

[11]  E. Feuer,et al.  Trends in use of adjuvant multi-agent chemotherapy and tamoxifen for breast cancer in the United States: 1975-1999. , 2002, Journal of the National Cancer Institute.

[12]  S. Woolf,et al.  Breast Cancer Screening: A Summary of the Evidence for the U.S. Preventive Services Task Force , 2002, Annals of Internal Medicine.

[13]  Multi-agent chemotherapy for early breast cancer. , 2002, The Cochrane database of systematic reviews.

[14]  Ingvar Andersson,et al.  Long-term effects of mammography screening: updated overview of the Swedish randomised trials , 2002, The Lancet.

[15]  S. Goodman.  The Mammography Dilemma: A Crisis for Evidence-Based Medicine? , 2002, Annals of Internal Medicine.

[16]  L. Clegg,et al.  Adjuvant therapy for breast cancer: practice patterns of community physicians. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[17]  W. P. Evans,et al.  American Cancer Society Guidelines for Breast Cancer Screening: Update 2003 , 2003, CA: a cancer journal for clinicians.

[18]  D. M. Parkin,et al.  Corrigendum to “Cancer burden in the year 2000. The global picture” [European Journal of Cancer,37(Suppl. 8) (2001) S4–S66] , 2003 .

[19]  Nancy Breen,et al.  Progress in cancer screening practices in the United States , 2003, Cancer.

[20]  E. Feuer,et al.  Modeling the dissemination of mammography in the United States , 2005, Cancer Causes & Control.