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Evaluation of service screening mammography in practice: the impact on breast cancer mortality

2005; Elsevier BV; Volume: 16; Linguagem: Inglês

10.1093/annonc/mdi718

1569-8041

Rhian Gabe, Stephen W. Duffy,

Cancer Risks and Factors

The efficacy of screening for breast cancer using mammography has been proven through eight randomised controlled trials (RCTs), the first being initiated in 1963 in New York [1]. The combined results of these studies after 12–20 years of follow-up demonstrate a significant 20% reduction in breast cancer mortality associated with invitation to screening [2]. The randomised evidence has led several organisations and governments around the world to implement screening programmes. Therefore, the focus has now moved from the randomised environment to measuring the effect of service screening mammography in the routine health-care setting, much in the same way that phase IV studies are carried out to monitor effects of a new drug in the post-marketing epoch. Reasons why the effectiveness of service screening mammography may differ from that observed in the randomised trials include: (i) the wider base of professionals carrying out service screening may have different skills and abilities; (ii) the logistics of running a mass screening programme may differ from the organisation of trial screening; (iii) the population invited may differ from those offered screening in the RCTs in terms of both risk of disease and compliance; (iv) mammographic and other techniques involved in the screening process may have improved since the trials were conducted; and (v) other factors such as therapeutic advances and earlier diagnosis through increased breast cancer awareness will influence outcomes.