programas cribado cancer


Nota Bibliográfica

Esta Nota es una recopilación de publicaciones (artículos, informes, libros) sobre cribado de cáncer resultado de una revisión no sistemática de la literatura.

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Josep A Espinás. Pla Director d'Oncología de Catalunya.
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Nota bibliográfica cribado c mama 2014-11

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 Public Health. 2014;24(6):1016–21. Available from:

Conclusion: Incidence of localized breast cancer increased significantly among women aged 50–69 years old after introduction of screening, while the incidence of more advanced cancers was not reduced in the same period when compared to the younger unscreened age group.

Andersen SB, Törnberg S, Lynge E, Von Euler-Chelpin M, Njor SH. A simple way to measure the burden of interval cancers in breast cancer screening. BMC Cancer. London; 2014;14(1):782. Available from: doi: 10.1186/1471-2407-14-782.

CONCLUSION: This alternate measure seems to capture the burden of interval cancers just as well as the traditional PICR, without need for the increasingly difficult estimation of background incidence, making it a more accessible tool when evaluating mammography screening program performance.

AL Mousa DS, Mello-Thoms C, Ryan EA, Lee WB, Pietrzyk MW, Reed WM, et al. Mammographic Density and Cancer Detection: Does Digital Imaging Challenge our Current Understanding?. Acad Radiol. 2014;21(11):1377–85. Available from: doi:

Conclusions Increased mammographic density improves the performance of experienced radiologists when using digital mammograms. This finding, which does not align with those previously reported for film screen systems, may be because of windowing/leveling opportunities available with digital images.

WHO. WHO position paper on mammography screening. Geneva:Switzerland; 2014.
Recommendations by age group and resource setting 1. Women aged 50−69 years 1.1 Well-resourced settings In well-resourced settings, WHO recommends 1 organized, populationbased mammography screening programmes for women aged 50−69 years if the conditions for implementing an organized programme specified in this guide 2 are met by the health-care system, and if shared decisionmaking strategies are implemented so that women’s decisions are consistent with their values and preferences. (Strong recommendation based on moderate quality evidence) WHO suggests a screening interval of two years. (Conditional recommendation based on low quality evidence) 1.2 Limited resource settings with relatively strong health systems In limited resource settings with relatively strong health systems, WHO suggests 3 considering an organized, population-based mammography screening programme for women aged 50−69 years only if the conditions for implementing an organized programme specified in this guide 4 are met by the health-care system, and if shared decision-making strategies are implemented so that women’s decisions are consistent with their values and preferences. (Conditional recommendation based on moderate quality evidence) WHO suggests a screening interval of two years. (Conditional recommendation based on low quality evidence) 1.3 Limited resource settings with weak health systems In limited resource settings with weak health systems, where the majority of women with breast cancer are diagnosed in late stages and mammography screening is not cost-effective and feasible, early diagnosis of breast cancer through universal access of women with symptomatic lesions to prompt and effective diagnosis and treatment should be high 1. According to GRADE, “recommend” is used when there is a strong recommendation. 2. See Box 1, page 8. 3. According to GRADE, “suggest” is used when there is a conditional recommendation. 4. See Box 1, page 8. 12 WHO position paper on mammography screening on the public health agenda (WHO, 2013). Clinical breast examination, a low-cost screening method, seems to be a promising approach for these settings and could be implemented when the necessary evidence from ongoing studies becomes available (Sankaranarayanan et al., 2011). 2. Women aged 40−49 years 2.1 Well-resourced settings In well-resourced settings, WHO suggests an organized, population-based screening programme for women aged 40−49 years only if such programme is conducted in the context of…

Tabár L, Yen AM-F, Wu WY-Y, Chen SL-S, Chiu SY-H, Fann JC-Y, et al. Insights from the Breast Cancer Screening Trials: How Screening Affects the Natural History of Breast Cancer and Implications for Evaluating Service Screening Programs. Breast J. 2014;n/a – n/a. Available from: doi: 10.1111/tbj.12354.

This study provides evidence that the average mortality reduction in all the trials underestimates the true mortality reduction, and that substantially greater breast cancer mortality reductions can be expected in screening programs that are effective in reducing advanced stage breast cancer. In addition, monitoring the incidence of advanced stage breast cancer in an ongoing screening program can provide a sensitive and early indicator of the subsequent mortality from the disease.

Bargallo X, Santamaria G, Del Amo M, Arguis P, Rios J, Grau J, et al. Single reading with computer-aided detection performed by selected radiologists in a breast cancer screening program.Eur J Radiol. Ireland; 2014;83(11):2019–23. doi: 10.1016/j.ejrad.2014.08.010. PMID: 25193778.

CONCLUSIONS: The cancer detection rate of the screening program improved using a single reading protocol by experienced radiologists assisted by CAD, at the cost of a moderate increase of the recall rate mainly related to the lack of arbitration.

Altobelli E, Lattanzi A. Breast cancer in European Union: an update of screening programmes as of March 2014 (review). Int J Oncol. Greece; 2014;45(5):1785–92. doi: 10.3892/ijo.2014.2632. PMID: 25174328.

 Breast cancer, a major cause of female morbidity and mortality, is a global health problem; 2008 data show an incidence of ~450,000 new cases and 140,000 deaths (mean incidence rate 70.7 and mortality rate 16.7, world age-standardized rate per 100,000 women) in European Union Member States. Incidence rates in Western Europe are among the highest in the world. We review the situation of BC screening programmes in European Union. Up to date information on active BC screening programmes was obtained by reviewing the literature and searching national health ministries and cancer service websites. Although BC screening programmes are in place in nearly all European Union countries there are still considerable differences in target population coverage and age and in the techniques deployed. Screening is a mainstay of early BC detection whose main weakness is the rate of participation of the target population. National policies and healthcare planning should aim at maximizing participation in controlled organized screening programmes by identifying and lowering any barriers to adhesion, also with a view to reducing healthcare costs.


Nota bibliográfica cribado c mamal 2014-10

Vidal C, Garcia M, Benito L, Milà N, Binefa G, Moreno V. Use of Text-Message Reminders to Improve Participation in a Population-Based Breast Cancer Screening Program. J Med Syst. New York; 2014;38(9):1–118. Available from: doi:

To analyze the effect of a cell text message reminder service on participation in a mammogram screening program in Catalonia, Spain. A quasi-experimental design was used with women aged 50 to 69 years who had been scheduled mammogram appointments in June or July 2011. Women were personally invited by letter to attend to the breast cancer screening program (n=12,786). Prior to the invitation, 3,719 (29.1 %) of them had provided their cell telephone number to the National Health Service. These women received a text message reminder 3 days before their scheduled appointment. Logistic regression models were used to analyze whether the text message reminder was associated with participation in screening. Cost-effectiveness of adding a text message reminder to the invitation letter was also analyzed. The overall rate of participation in breast cancer screening was 68.4 %. The participation rate was significantly higher in the text messaging group, with an age-adjusted OR of 1.56 (95 %CI: 1.43-1.70). A detailed analysis showed that the increase in participation related to the text message reminder was higher among women without previous screening who lived in areas where access to postal mail was limited (OR=2.85; 95 %CI: 2.31-3.53) compared to those who lived in areas of easier postal mail access (OR=1.66; 95 %CI: 1.36-2.02). The invitation letter+text message reminder was a cost-effective strategy. Text message reminders are an efficient cost-effective approach to improve participation in difficult-to-reach populations, such as rural areas and newly developed suburbs.

Tupper R, Holm K. Screening Mammography and Breast Cancer Reduction: Examining the Evidence. J Nurse Pract. 2014;10(9):721–8. Available from: doi:

Better treatment and awareness may explain much of the decline in breast cancer deaths in recent years, not mammography. For women without a family history of breast cancer, the risks of screening mammography may outweigh the benefits, particularly for women younger than age 50. Mammography carries the risk of overdiagnosis of tumors that would not have caused death. Nurse practitioners are advised to educate their patients on mammography risks and benefits while increasing their emphasis on the clinical symptoms of breast cancer and ways to reduce risk, including weight control, decreased alcohol use, and decreased use of menopausal estrogen


Nota bibliográfica cribado c mama 2014-09

Natal C, Caicoya M, Prieto M, Tardón A. Incidencia de cáncer de mama en relación con la participación en un programa de cribado poblacional. Med Clin (Barc). 2014;(x). Available from: doi: 10.1016/j.medcli.2014.04.028.

Ascunce N. Sobrediagnóstico en programas de cribado de cáncer de mama: un efecto adverso inevitable que debe tenerse en cuenta. Med Clin (Barc). 2014;(x). Available from: doi: 10.1016/j.medcli.2014.07.017. PMID: 25178546.

Heinävaara S, Sarkeala T, Anttila A. Overdiagnosis due to breast cancer screening: updated estimates of the Helsinki service study in Finland. Br J Cancer. 2014;111(7):1463–8. Available from: doi: 10.1038/bjc.2014.413. PMID: 25121953.

Conclusions:Our estimates of overdiagnosis are of the same magnitude than other plausible estimates in Europe. Both alternative approaches produced similar estimates for the expected cumulative incidence, which increased the confidence in the estimates of overdiagnosis.

Overdiagnosis from mammographic screening. Position Statment. 2014.
Summary Cancer Australia supports the importance of mammographic screening in reducing breast cancer mortality. The national BreastScreen Australia Evaluation indicated a reduction in breast cancer mortality for the age group of 50-69 years of approximately 21-28% at the participation level of 56%. Participation in the BreastScreen Australia Program would result in around 8 deaths prevented for every 1000 women screened every two years from age 50 to age 74. A majority of breast cancers found through screening would be progressive and would become symptomatic within a woman’s lifetime if left untreated. It is likely that some screen-detected breast cancers (ductal carcinoma in situ or invasive breast cancer) might never have progressed to become symptomatic in a woman’s lifetime. Detection of these cancers is sometimes referred to as “overdiagnosis”. It is not possible to precisely predict at diagnosis, to which cancers overdiagnosis would apply. Estimates of overdiagnosis vary widely. Based on UK and European reviews, it is estimated that for every 1000 women in Australia who are screened every two years from age 50 to age 74, around 8 (between 2 and 21) breast cancers may be found and treated that would not have been found in a woman’s lifetime. Research is needed, including molecular and genomic research, to find means of identifying cancers that would be of minimal risk of progression and therefore could be managed more conservatively.

Bell RJ. Screening mammography - early detection or over-diagnosis? Contribution from Australian data. Climacteric. 2014;1–7. Available from: doi: 10.3109/13697137.2014.956718. PMID: 25224048.

Conclusions The benefits and harms of screening mammography are finely balanced. The impact of screening mammography is at best neutral but may result in overall harm. Women should be informed of the issue of over-diagnosis. It is time to review whether organized mammographic screening programs should continue.

Waller J, Whitaker KL, Winstanley K, Power E, Wardle J. A survey study of women’s responses to information about overdiagnosis in breast cancer screening in Britain. Br J Cancer. 2014;(August):1–5. Available from: doi: 10.1038/bjc.2014.482. PMID: 25167224.

Conclusions:Brief written information on overdiagnosis was incompletely understood, but reduced breast screening intentions in a proportion of women, regardless of comprehension. Subjective comprehension was lower among women who had not yet reached screening age but the deterrent effect was higher.British Journal of Cancer advance online publication, 28 August 2014; doi:10.1038/bjc.2014.482

Munoz D, Near AM, van Ravesteyn NT, Lee SJ, Schechter CB, Alagoz O, et al. Effects of Screening and Systemic Adjuvant Therapy on ER-Specific US Breast Cancer Mortality. J Natl Cancer Inst. 2014;106(11). Available from: doi: 10.1093/jnci/dju289.

Conclusion As advances in risk assessment facilitate identification of women with increased risk of ER-negative breast cancer, additional mortality reductions could be realized through more frequent targeted screening, provided these benefits are balanced against screening harms.

Coldman A, Phillips N, Wilson C, Decker K, Chiarelli AM, Brisson J, et al. Pan-Canadian Study of Mammography Screening and Mortality from Breast Cancer. J Natl Cancer Inst. 2014;106(11). Available from: doi: 10.1093/jnci/dju261.

Conclusion Participation in mammography screening programs in Canada was associated with substantially reduced breast cancer mortality


Nota bibliográfica cribado c mama 2014-07/08

Irvin VL, Kaplan RM. Screening mammography & breast cancer mortality: meta-analysis of quasi-experimental studies. PLoS One. 2014;9(6):e98105. Available from:  doi: 10.1371/journal.pone.0098105. PMID: 24887150.

CONCLUSIONS: Mammography screening may have modest effects on cancer mortality between the ages of 50 and 69 and non-significant effects for women older than age 70. Results are consistent with meta-analyses of RCTs. Effects on total mortality could not be assessed because of the limited number of studies.

Cedolini C, Bertozzi S, Londero AP, Bernardi S, Seriau L, Concina S, et al. Type of Breast Cancer Diagnosis, Screening, and Survival. Clin Breast Cancer. 2014;14(4):235–40. Available from: doi:

Conclusion The diagnosis of invasive breast cancer with screening in our population resulted in a survival gain at 5 years from the diagnosis, but a longer follow-up is necessary to confirm this data.

Fuhrman BJ, Byrne C. Comparing Mammographic Measures Across Populations (editorial]. J Natl Cancer Inst. 2014;106(5). Available from:  doi: 10.1093/jnci/dju109.

Pettersson A, Graff RE, Ursin G, dos Santos Silva I, McCormack V, Baglietto L, et al. Mammographic Density Phenotypes and Risk of Breast Cancer: A Meta-analysis. J Natl Cancer Inst. 2014;106(5). Available from:  doi: 10.1093/jnci/dju078.

Conclusions The results suggest that percentage dense area is a stronger breast cancer risk factor than absolute dense area. Absolute nondense area was inversely associated with breast cancer risk, but it is unclear whether the association is independent of absolute dense area.

Luqmani Y. Breast screening: an obsessive compulsive disorder. Cancer Causes Control. 2014;1–4. Available from: doi: 10.1007/s10552-014-0430-2.

Brand JS, Czene K, Shepherd JA, Leifland K, Heddson B, Sundbom A, et al. Automated measurement of volumetric mammographic density: a tool for widespread breast cancer risk assessment. Cancer Epidemiol Biomarkers Prev. 2014; Available from: doi: 10.1158/1055-9965.EPI-13-1219.

Conclusions: In a high-throughput setting Volpara performs well and in accordance with the behavior of established density measures. Impact: Automated measurement of volumetric mammographic density is a promising tool for widespread breast cancer risk assessment.

Berg WA. How Well Does Supplemental Screening Magnetic Resonance Imaging Work in High-Risk Women ? J Clin Oncol. 2014;1–5. doi: 10.1200/JCO.2014.56.2975.

Chiarelli AM, Prummel M V, Muradali D, Majpruz V, Horgan M, Carroll JC, et al. Effectiveness of Screening With Annual Magnetic Resonance Imaging and Mammography: Results of the Initial Screen From the Ontario High Risk Breast Screening Program. J Clin Oncol. 2014; Available from: doi: 10.1200/JCO.2013.52.8331.

Conclusion Screening with annual MRI combined with mammography has the potential to be effectively implemented into an organized breast screening program for women at high risk for breast cancer. This could be considered an important management option for known BRCA gene mutation carriers.

Molinié F, Vanier A, Woronoff AS, Guizard A V, Delafosse P, Velten M, et al. Trends in breast cancer incidence and mortality in France 1990–2008. Breast Cancer Res Treat. 2014;147(1):167–75. Available from: doi: 10.1007/s10549-014-3073-9.

 The objective of this work was to detail the incidence and mortality trends of invasive and in situ breast cancer (BC) in France, especially regarding the development of screening, over the 1990–2008 period. Data issued from nine population-based cancer registries were studied. The incidence of invasive BC increased annually by 0.8 % from 1990 to 1996 and more markedly by 3.2 % from 1996 to 2003, and then sharply decreased until 2006 (−2.3 % per year), especially among women aged 50–69 years (−4.9 % per year). This trend was similar whatever the introduction date of the organized screening (OS) program in the different areas. The incidence of ductal carcinoma in situ steadily increased between 1990 and 2005, particularly among women aged 50–69 years and 70 and older. At the same time, the mortality from BC decreased annually by 1.1 % over the entire study period. This decrease was more pronounced in women aged 40–49 and 50–69 and, during the 1990–1999 period, in the areas where OS began in 1989–1991. The similarity in the incidence trends for all periods of implementation of OS in the different areas was striking. This suggests that OS alone does not explain the changes observed in incidence rate. Our study highlights the importance of closely monitoring the changes in incidence and mortality indicators, and of better understanding the factors causing variation.

Houssami N, Macaskill P, Bernardi D, Caumo F, Pellegrini M, Brunelli S, et al. Breast screening using 2D-mammography or integrating digital breast tomosynthesis (3D-mammography) for single-reading or double-reading – Evidence to guide future screening strategies. Eur J Cancer. 2014;50(10):1799–807. Available from: doi: 10.1016/j.ejca.2014.03.017. PMID: 24746887.

CONCLUSION: The evidence we report warrants rethinking of breast screening strategies and should be used to inform future evaluations of 2D/3D-mammography that assess whether or not the estimated incremental detection translates into improved screening outcomes such as a reduction in interval cancer rates.

Renart-Vicens G, Puig-Vives M, Albanell J, Castaner F, Ferrer J, Carreras M, et al. Evaluation of the interval cancer rate and its determinants on the Girona health region’s early breast cancer detection program. BMC Cancer. 2014;14(1):558. Available from:

CONCLUSIONS:The IC rate for the PEDBC is within the expected parameters, with a high proportion of cases of true interval cancers (54.5%) and a low proportion of false negatives (13.6%). The results show that the proportional incidence of IC is within the limits set by European Guidelines. Furthermore, it has been confirmed that IC display more aggressive clinicopathological characteristics than screening breast cancers.

Miller AB. Digital Mammography [editorial].  J Natl Cancer Inst. 2014;106(6). Available from:  doi: 10.1093/jnci/dju125.

Kerlikowske K, Hubbard R, Tosteson ANA. Higher Mammography Screening Costs Without Appreciable Clinical Benefit: The Case of Digital Mammography. J Natl Cancer Inst. 2014;106(8). Available from:  doi: 10.1093/jnci/dju191.

Missinne S, Bracke P. Age differences in mammography screening reconsidered: life course trajectories in 13 European countries. Eur J Public Health. 2014; Available from: doi: 10.1093/eurpub/cku077.

Conclusion: Age differences in mammography screening generally reflect the period effects of national screening policies. This leaves little room for economic theories about human health capital that leave out the institutional context of preventive health care provision.

Lerda D, Deandrea S, Freeman C, López-alcalde J, Neamtiu L, Nicholl C, et al. Report of a European survey breast cancer care services [Internet]. Luxembourg; 2014 p. VI–142. Available from:  doi: 10.2788/51070.

AL Mousa DS, Brennan PC, Ryan EA, Lee WB, Tan J, Mello-Thoms C. How Mammographic Breast Density Affects Radiologists’ Visual Search Patterns. Acad Radiol. (0). Available from: doi:

Conclusions. Increased mammographic breast density changes radiologists' visual search patterns. Dense areas of the parenchyma attracted greater visual attention in both high- and low-mammographic density cases, resulting in faster detection of lesions overlying the fibroglandular dense tissue, along with longer dwell times and greater number of fixations, as compared to lesions located outside the dense fibroglandular regions.

Sarkeala T, Luostarinen T, Dyba T, Anttila A. Breast carcinoma detection modes and death in a female population in relation to population-based mammography screening. Springerplus. 2014;3(1):348. Available from: doi: 10.1186/2193-1801-3-348.

Conclusions The study demonstrates a novel approach to examine associations between breast carcinoma incidence and mortality within and outside population-based screening. The results show mammography screening having a distinct role in overall breast carcinoma incidence and mortality.

Nederend J, Duijm LEM, Louwman MWJ, Roumen RMH, Jansen FH, Voogd AC. Trends in surgery for screen-detected and interval breast cancers in a national screening programme. Br J Surg. 2014;101(8):949–58. Available from:  doi: 10.1002/bjs.9530. PMID: 24828281.

CONCLUSION: Mastectomy rates doubled during a 14-year period of screening mammography and the proportion of positive resection margins decreased, with variation among hospitals. The latter observation stresses the importance of quality control programmes for hospitals treating women with breast cancer.

Hofvind S, Skaane P, Elmore JG, Sebuødegård S, Hoff SR, Lee CI. Mammographic performance in a population-based screening program: before, during, and after the transition from screen-film to full-field digital mammography. Radiology. 2014;272(1):52–62. Available from:  doi: 10.1148/radiol.14131502. PMID: 24689858.

CONCLUSION: After the initial transitional phase from SFM to FFDM, population-based screening with FFDM is associated with less harm because of lower recall and biopsy rates and higher positive predictive values after biopsy than screening with SFM.


Nota bibliográfica cribado c mama 2014-06

Bolton KC, Mace JL, Vacek PM, Herschorn SD, James TA, Tice JA, et al. Changes in Breast Cancer Risk Distribution Among Vermont Women Using Screening Mammography. J Natl Cancer Inst. 2014;106(8).
 Available from: doi: 10.1093/jnci/dju157.

Conclusions The observed decline in women screened in Vermont in recent years is largely attributable to reductions in screening visits by women who are at low risk of developing breast cancer.

Smith RA. The Value of Modern Mammography Screening in the Control of Breast Cancer: Understanding the Underpinnings of the Current Debates. Cancer Epidemiol Biomarkers Prev. 2014;23(7):1139–46. Available from: doi: 10.1158/1055-9965.EPI-13-0946.

Since the introduction of mammography screening, debates about the value of screening have endured and been contentious. Recent reviews of the randomized controlled trials reach different conclusions about the absolute benefit of screening, as do evaluations of population trends in breast cancer mortality and the evaluations of service screening. Conclusions about the value of screening commonly are expressed in terms of the balance of benefits and harms, which can differ greatly even when derived seemingly from the same data. It can be shown when different estimates are adjusted to a common screening and follow-up scenario, differences in balance sheet estimates diminish substantially. The strong evidence of benefit associated with exposure to modern mammography screening suggests that it is time to move beyond the randomized controlled trial estimates of benefit and consider policy decisions on the basis of benefits and harms estimated from the evaluation of current screening programs.

Paci E, Broeders M, Hofvind S, Puliti D, Duffy SW, Group the EW. European Breast Cancer Service Screening Outcomes: A First Balance Sheet of the Benefits and Harms. Cancer Epidemiol Biomarkers Prev. 2014;23(7):1159–63.
 Available from: doi: 10.1158/1055-9965.EPI-13-0320.

A recent comprehensive review has been carried out to quantify the benefits and harms of the European population-based mammographic screening programs. Five literature reviews were conducted on the basis of the observational published studies evaluating breast cancer mortality reduction, breast cancer overdiagnosis, and false-positive results. On the basis of the studies reviewed, the authors present a first estimate of the benefit and harm balance sheet. For every 1,000 women screened biennially from ages 50 to 51 years until ages 68 to 69 years and followed up until age 79 years, an estimated seven to nine breast cancer deaths are avoided, four cases are overdiagnosed, 170 women have at least one recall followed by noninvasive assessment with a negative result, and 30 women have at least one recall followed by invasive procedures yielding a negative result. The chance of a breast cancer death being avoided by population-based mammography screening of appropriate quality is more than that of overdiagnosis by screening. These outcomes should be communicated to women offered service screening in Europe.

Coyle C, Kinnear H, Rosato M, Mairs A, Hall C, O’Reilly D. Do women who intermittently attend breast screening differ from those who attend every invitation and those who never attend? J Med Screen. 2014;21(2):98–103.
Available from: doi: 10.1177/0969141314533677.

Conclusions One-time attenders are an important and distinct subgroup of screening invitees in this analysis. Their distinct characteristics suggest that transitory factors, such as change in marital status, ill-health, or addressing difficulties through change of residence are important. These distinct characteristics suggest the need for different approaches to increase attendance, among both intermittent attenders and those not attending at all.

Kopans DB, Webb ML, Cady B. The 20-year effort to reduce access to mammography screening: Historical facts dispute a commentary in Cancer. Cancer. 2014;n/a–n/a. Available from: doi: 10.1002/cncr.28791.

Mammography screening fulfills all requirements for an effective screening test. It detects many cancers earlier when they are at a smaller size and earlier stage, and it has been demonstrated that this reduces breast cancer deaths in randomized controlled trials. When screening is introduced into the population, the death rate from breast cancer declines. Nevertheless, scientifically unsupported arguments that appear in the medical literature are passed on to the public and continue to confuse women and physicians regarding the value of screening. Methodologically flawed challenges to mammography have been almost continuous since the 1990s. And, as each challenge has been invalidated, a new, specious challenge has been raised. The authors of this report address the long history of misinformation that has developed in the effort to reduce access to screening, and they address the issues raised by commentators concerning their recent publication in this journal.

Friedewald SM, Rafferty  EA, Rose SL, et al.. Breast cancer screening using tomosynthesisin combination with digital mammography. JAMA. 2014;311(24):2499–507. Available from:

Conclusions and Relevance Addition of tomosynthesis to digital mammography was associated with a decrease in recall rate and an increase in cancer detection rate. Further studies are needed to assess the relationship to clinical outcomes.

Duffy SW. Recent results from the two Canadian Breast Screening Trials. J Med Screen. 2014;21(2):59–60. Available from: doi: 10.1177/0969141314537615.
Weedon-Fekjær H, Romundstad PR, Vatten LJ. Modern mammography screening and breast cancer mortality: population study. BMJ. 2014;348. Available from:

Conclusion Invitation to modern mammography screening may reduce deaths from breast cancer by about 28%.

Elmore JG, Harris RP. The harms and benefits of modern screening mammography (editorial). BMJ. 2014;348. Available from:

José Bento M, Gonçalves G, Aguiar A, Antunes L, Veloso V, Rodrigues V. Clinicopathological differences between interval and screen-detected breast cancers diagnosed within a screening programme in Northern Portugal. J Med Screen. 2014;21(2):104–9. Available from: doi: 10.1177/0969141314534406.

Conclusion Our results are consistent with other studies. IC’s have a more aggressive biology than SDs. Our findings did not show any unexpected pattern requiring changes to our screening procedures, but continuous identification and characterization of IC is advisable.

Brawley OW. Breast Cancer Screening. Time for Rational Discourse (editorial). Cancer. 2014;(Published online Month 00, 2014):4–6. Available from: doi: 10.1002/cncr.28788.

Berry DA. Failure of Researchers , Reviewers , Editors , and the Media to Understand Flaws in Cancer Screening Studies. Cancer. 2014;(Article first published online: 12 JUN 2014):1–8. doi: 10.1002/cncr.28795.

Observational studies present inferential challenges. These challenges are acute in cancer screening studies, in which lead-time and length biases are ever present. These biases can make any study worthless. Moreover, a flawed study’s impact on the public can be deleterious when its conclusions are publicized by a naïve media. Flawed studies can also make the public learn to be wary of any article or reports of articles claiming to be scientific. Here, the author addresses these and related issues in the context of a study published in Cancer.

Pisano ED, Yaffe MJ. Breast cancer screening: Should tomosynthesis replace digital mammography? [editorial] JAMA. 2014;311(24):2488–9. Available from:

Printz C. Mammogram debate flares up: Latest breast cancer screening study fuels controversy. Cancer. 2014;120(12):1755–6. Available from: doi: 10.1002/cncr.28803.

Cheddad A, Czene K, Shepherd JA, Li J, Hall P, Humphreys K. Enhancement of Mammographic Density Measures in Breast Cancer Risk Prediction. Cancer Epidemiol Biomarkers Prev. 2014;23(7):1314–23. Available from: doi: 10.1158/1055-9965.EPI-13-1240.

Conclusions: MIP is a marker of volumetric density that can be used to complement area PD in mammographic density studies and breast cancer risk assessment.Impact: Inclusion of MIP in risk models should be considered for studies using area PD from analog films. Cancer Epidemiol Biomarkers Prev; 23(7); 1314–23.

Webb M, Cady B, Michaelson J. A failure analysis of invasive breast cancer. Cancer. 2013;1–8. Available from: doi: 10.1002/cncr.28199.

CONCLUSIONS Most deaths from breast cancer occur in unscreened women. To maximize mortality reduction and life-years gained, initiation of regular screening before age 50 years should be encouraged.


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