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 2013-09

Njor SH, Garne JP, Lynge E. Over-diagnosis estimate from The Independent UK Panel on Breast Cancer Screening is based on unsuitable data. J Med Screen. 2013;20(2):104–5. Available from: doi: 10.1177/0969141313495190.

Paci E, Smith R, Broeders M, Duffy S. Complex statistical techniques cannot overcome weak methodology in the evaluation of breast cancer mortality trends. J R Soc Med. 2013;106(9):346.
Available from: doi: 10.1177/0141076813501807.

NICE.   Classification and care of people at risk of familial breast cancer and management of breast cancer and related risks in people with a family history of breast cancer. Manchester; 2013.

Mukhtar TK, Yeates DRG, Goldacre MJ. Breast cancer mortality trends in England and the assessment of the effectiveness of mammography screening: population-based study. J R Soc Med. 2013;106(6):234–42. Available from: doi: 10.1177/0141076813486779.
Conclusions Mortality statistics do not show an effect of mammographic screening on population-based breast cancer mortality in England.

Maxwell AJ, Beattie C, Lavelle J, Lyburn I, Sinnatamby R, Garnett S, et al. The effect of false positive breast screening examinations on subsequent attendance: retrospective cohort study. J Med Screen. 2013;20(2):91–8. Available from: doi: 10.1177/0969141313499147.
Conclusions The findings suggest that most women who undergo the breast screening assessment process retain confidence in breast screening. Needle sampling and open biopsy should be used judiciously in the assessment of screen-detected abnormalities in view of the reduced reattendance that results from their use after incident screening examinations.

Webb ML, Cady B, Michaelson JS, Bush DM, Calvillo KZ, Kopans DB, et al. A failure analysis of invasive breast cancer. Cancer. 2013;n/a–n/a. Available from: 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.

 Kerlikowske K, Zhu W, Hubbard RA, Geller B, Dittus K, Braithwaite D, et al. Outcomes of screening mammography by frequency, breast density, and postmenopausal hormone therapy. JAMA Intern Med. 2013;173(9):807–16. doi: 10.1001/jamainternmed.2013.307; 10.1001/jamainternmed.2013.307.
CONCLUSIONS AND RELEVANCE: Women aged 50 to 74 years, even those with high breast density or HT use, who undergo biennial screening mammography have similar risk of advanced-stage disease and lower cumulative risk of false-positive results than those who undergo annual mammography. When deciding whether to undergo mammography, women aged 40 to 49 years who have extremely dense breasts should be informed that annual mammography may minimize their risk of advanced-stage disease but the cumulative risk of false-positive results is h…

Omer ZB  Esserman LJ, Howe R,Ozanne EM HE. IMpact of ductal carcinoma in situ terminology on patient treatment preferences. JAMA Intern Med. 2013;-. Available from: doi: 10.1001/jamainternmed.2013.8405.
 Ductal carcinoma in situ (DCIS) is a preinvasive malignancy of the breast and is diagnosed in more than 50?000 women a year in the United States. It is treated with either mastectomy or lumpectomy, often combined with radiation therapy.1 In cases of low-grade DCIS, studies suggest that if progression occurs, it does so within a time frame of 5 to 40 years2 and possibly in only 20% of DCIS cases.3 This raises the possibility that some cases of DCIS will follow an indolent course that will not attain clinical significance during the patient's lifetime. Accordingly, watchful waiting has been proposed as a reasonable option for DCIS,4 akin to what is currently offered for patients with early stage prostate cancer; however, how to implement such a strategy is unclear.

Njor SH, von Euler-Chelpin M. Information to women invited to mammography screening. Ann Oncol. 2013;24(10):2467–8.
Available from: doi: 10.1093/annonc/mdt373.

Berry DA. Breast cancer screening: Controversy of impact. St Gall 2013 Proc B. 2013;22, Supple(0):S73–S76.
Available from: doi:
 Abstract Few medical issues have been as controversial or as political, at least in the United States as the role of mammographic screening for breast cancer. The advantages of finding a cancer early seem obvious. Indeed, randomized trials evaluating screening mammography demonstrate a reduction in breast cancer mortality, but the benefits are less than one would hope. Moreover, the randomized trials are themselves subject to criticism, including that they are irrelevant in the modern era because most were conducted before chemotherapy and hormonal therapy became widely used. In this article I chronicle the evidence and controversies regarding mammographic screening, including attempts to assess the relative contributions of screening and therapy in the substantial decreases in breast cancer mortality that have been observed in many countries over the last 20-25 years. I emphasize the trade-off between harms and benefits depending on the woman’s age and other risk factors. I also discuss ways for communicating the associated risks to women who have to decide whether screening (and what screening strategy) is right for them.

Lynge E, Ponti A, James T, Mojek O, von Euler-Chelpin M, Anttila A, et al. Variation in detection of ductal carcinoma in situ during screening mammography: A survey within the International Cancer Screening Network. Eur J Cancer. (0).
Available from: doi:
Conclusions Considerable international variation was found in DCIS detection. This variation could not be fully explained by variation in incidence nor in breast cancer detection rates. It suggests the potential for wide discrepancies in management of DCIS resulting in overtreatment of indolent DCIS or undertreatment of potentially curable disease. Comprehensive cancer registration is needed to monitor DCIS detection. Efforts to understand discrepancies and standardise management may improve care.


Nota bibliográfica cribado c mama 2013-07/08

Whelehan P, Evans A, Wells M, Macgillivray S. The effect of mammography pain on repeat participation in breast cancer screening: A systematic review. Breast 2013 Aug;22(4):389-394. DOI:10.1016/j.breast.2013.03.003; 10.1016/j.breast.2013.03.003. PMID:23541681.

The most robust evidence for an association between pain experienced at a previous mammogram and subsequent rates of re-attendance suggests that women who previously experienced pain are more likely than those who did not to fail to re-attend: RR 1.34 (95% CI: 0.94-1.91). The complexity of the pain phenomenon and of screening behaviours must be recognised. However, there is sufficient evidence to conclude that painful mammography contributes to non-re-attendance. Given the importance of cumulative participation, effective pain-reducing interventions in mammography are needed.

van Breest Smallenburg V, Nederend J, Voogd AC, Coebergh JW, van Beek M, Jansen FH, et al. Trends in breast biopsies for abnormalities detected at screening mammography: a population-based study in the Netherlands. Br J Cancer 2013 Jul 9;109(1):242-248. DOI:10.1038/bjc.2013.253; PMID:23695018.

Conclusion:The use of diagnostic surgical breast biopsies has decreased substantially. They have mostly been replaced by percutaneous CBs and this replacement did not result in an increase of diagnostic delays.

Gotzsche PC, Jorgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev 2013 Jun 4;6:CD001877. DOI:10.1002/14651858.CD001877.pub5; PMID:23737396.

AUTHORS' CONCLUSIONS: If we assume that screening reduces breast cancer mortality by 15% and that overdiagnosis and overtreatment is at 30%, it means that for every 2000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive finding.

van Luijt PA, Fracheboud J, Heijnsdijk EAM, den Heeten GJ, de Koning HJ. Nation-wide data on screening performance during the transition to digital mammography: Observations in 6 million screens. Eur J Cancer (0) DOI:

Conclusion In accordance to previous, smaller, studies, we can confirm that DM has a higher detection rate compared to SFM, at the cost of a higher recall rate and lower PPV. More DCIS and a higher fraction of very small tumours were detected with DM, which has positive consequences for the stage shift as a result of mass screening.

Kristiansen M, Lue-Kessing L, Mygind A, Razum O, Norredam M. Migration from low- to high-risk countries: a qualitative study of perceived risk of breast cancer and the influence on participation in mammography screening among migrant women in Denmark. European Journal of Cancer Care 2013:n/a-n/a. DOI:10.1111/ecc.12100.

Migrants are less likely to participate in mammography screening programmes compared with local-born populations in Europe. We explored perceptions of breast cancer risk and the influence on participation in mammography screening programmes among migrant women born in countries with low incidence rates of breast cancer. We conducted eight individual interviews and six group interviews including a total of 29 women aged 50?69 years living in Copenhagen, Denmark. Women were migrants born in Somalia, Turkey, Pakistan or Arab countries. Phenomenological analysis was used. Breast cancer was perceived to be caused by multiple factors, including genetics, health behaviour, stress, fertility and breastfeeding. Some women perceived breast cancer to be more prevalent in Denmark as compared with their country of birth, and perceived their risk of developing breast cancer to increase with length of stay in Denmark. Although most women agreed on the relevance of mammography screening, other cancers, chronic and infectious diseases and mental health problems were mentioned as equally or more important to target in public health programmes. A life course perspective comprising previous and current circumstances in country of birth as well as immigration country is important for understanding and influencing the screening behaviour of migrants.

Duffy SW, Parmar D. Overdiagnosis in breast cancer screening: the importance of length of observation period and lead time. Breast Cancer Res 2013 May 16;15(3):R41. DOI:10.1186/bcr3427. PMID:23680223. PMCID:PMC3706885.

CONCLUSION: Studies using shorter observation periods will overestimate overdiagnosis by inclusion of cancers diagnosed early due to lead time among the nominally overdiagnosed tumours.

 Feig SA. Pitfalls in accurate estimation of overdiagnosis: implications for screening policy and compliance. (editorial). Breast Cancer Res 2013 Aug 8;15(4):105. DOI:10.1186/bcr3448. PMID:23927453.

Stories in the public media that 30 to 50% of screen-detected breast cancers are overdiagnosed dissuade women from being screened because overdiagnosed cancers would never result in death if undetected yet do result in unnecessary treatment. However, such concerns are unwarranted because the frequency of overdiagnosis, when properly calculated, is only 0 to 5%. In the previous issue of Breast Cancer Research, Duffy and Parmar report that accurate estimation of the rate of overdiagnosis recognizes the effect of lead time on detection rates and the consequent requirement for an adequate number of years of follow-up. These indispensable elements were absent from highly publicized studies that overestimated the frequency of overdiagnosis.

Zahl PH, Jorgensen KJ, Gotzsche PC. Overestimated lead times in cancer screening has led to substantial underestimation of overdiagnosis. Br J Cancer 2013 Aug 20 DOI:10.1038/bjc.2013.427; PMID:23963144.

Conclusion:When overdiagnosis is not taken into account, lead time is substantially overestimated. Overdiagnosis adjusted for model-based lead time is a function tending to zero, with no simple interpretation. Furthermore, the estimates are not in general comparable, because they depend on both the duration of screening and duration of follow-up. In contrast, overdiagnosis adjusted for clinically relevant tumours is a point estimate (and interpreted as percentage), which we find is the most reasonable method.

Tilanus-Linthorst MM, Lingsma HF, Evans DG, Thompson D, Kaas R, Manders P, et al. Optimal age to start preventive measures in women with BRCA1/2 mutations or high familial breast cancer risk. Int J Cancer 2013 Jul;133(1):156-163. DOI:10.1002/ijc.28014; 10.1002/ijc.28014. PMID:23292943.

Women from high-risk families consider preventive measures for breast cancer including screening. Guidelines on screening differ considerably regarding starting age. We investigated whether age at diagnosis in affected relatives is predictive for age at diagnosis. We analyzed the age of breast cancer detection of 1,304 first- and second-degree relatives of 314 BRCA1, 164 BRCA2 and 244 high-risk participants of the Dutch MRI-SCreening study. The within- and between-family variance in the relative's age at diagnosis was analyzed with a random effect linear regression model. We compared the starting age of screening based on risk-group (25 years for BRCA1, 30 years for BRCA2 and 35 years for familial risk), on family history, and on the model, which combines both. The findings were validated in 63 families from the UK-MARIBS study. Mean age at diagnosis in the relatives varied between families; 95% range of mean family ages was 35-55 in BRCA1-, 41-57 in BRCA2- and 44-60 in high-risk families. In all, 14% of the variance in age at diagnosis, in BRCA1 even 23%, was explained by family history, 7% by risk group. Determining start of screening based on the model and on risk-group gave similar results in terms of cancers missed and years of screening. The approach based on familial history only, missed more cancers and required more screening years in both the Dutch and the United Kingdom data sets. Age at breast cancer diagnosis is partly dependent on family history which may assist planning starting age for preventive measures.


Nota bibliográfica cribado c mama 2013-06

Wübker A. Explaining variations in breast cancer screening across European countries. The European Journal of Health Economics 2013 06/07:1-18. DOI:10.1007/s10198-013-0490-3. Enlace:

Jagsi R, Hayman J. Informing Patient Decisions Regarding Management of Ductal Carcinoma In Situ. (editorial). Journal of the National Cancer Institute 2013 June 05;105(11):758-759. DOI:10.1093/jnci/djt113.

Soeteman DI, Stout NK, Ozanne EM, Greenberg C, Hassett MJ, Schrag D, et al. Modeling the Effectiveness of Initial Management Strategies for Ductal Carcinoma In Situ. Journal of the National Cancer Institute 2013 June 05;105(11):774-781. DOI:10.1093/jnci/djt096.

Conclusions Overall survival benefits of the six management strategies for DCIS are within 1 year, suggesting that treatment decisions can be informed by the patient’s preference for breast preservation and disutility for recurrence. Our delineation of personalized outcomes for each strategy can help patients understand the implications of their treatment choice, so their decisions may reflect their own personal values and help improve the quality of care for patients with DCIS.

Marmot MG. Sorting through the arguments on breast screening. JAMA 2013 May 30:1-2. DOI:10.1001/jama.2013.6822.
To those coming fresh to the argument, such disagreement seems surprising. Given the large body of evidence evaluating breast screening, it seems that the evidence would settle the issue. Such naiveté does not allow for the fact that people interpret evidence and, indeed, influence its generation. Judgments often reflect more about starting assumptions than they do about the nature of the evidence.

Puig-Vives M, Sanchez MJ, Sanchez-Cantalejo J, Torrella-Ramos A, Martos C, Ardanaz E, et al. Distribution and prognosis of molecular breast cancer subtypes defined by immunohistochemical biomarkers in a Spanish population-based study. Gynecol Oncol 2013 Jun 5 DOI:10.1016/j.ygyno.2013.05.039; PMID:23747837.
 CONCLUSION: The prognostic value of molecular subtype persists when adjusting for age, stage and histological grade. Hormone receptor positive tumors were associated with a better prognosis when compared with HER2-overexpressed and triple negative subtypes. Further research is required to improve triple negative prognosis.

Harris AL. Breast screening remains a controversial issue. (editorial). Br J Cancer 2013 Jun 11;108(11):2197. DOI:10.1038/bjc.2013.259; 10.1038/bjc.2013.259. PMID:23744282.

Hall P, Easton D. Breast cancer screening: time to target women at risk. (editorial). Br J Cancer 2013 Jun 11;108(11):2202-2204. DOI:10.1038/bjc.2013.257; 10.1038/bjc.2013.257. PMID:23744280.

Wu YY, Yen MF, Yu CP, Chen HH. Individually tailored screening of breast cancer with genes, tumour phenotypes, clinical attributes, and conventional risk factors. Br J Cancer 2013 May 14 DOI:10.1038/bjc.2013.202; 10.1038/bjc.2013.202. PMID:23674086.

Conclusion:We developed a novel quantitative approach following the principle of translational research to provide a roadmap with state-of-the-art genomic discovery and clinical parameters to facilitate individually tailored breast cancer screening.
Ceugnart L, Séradour B, Taieb S, Barreau B. Que penser des polémiques récentes sur le dépistage organisé des cancers du sein? Oncologie 2013 06/14:1-3. DOI:10.1007/s10269-013-2297-3. Enlace:

Otten JDM, Fracheboud J, den Heeten GJ, Otto SJ, Holland R, de Koning HJ, et al. Likelihood of early detection of breast cancer in relation to false-positive risk in life-time mammographic screening: population-based cohort study. Annals of Oncology 2013 June 19 DOI:10.1093/annonc/mdt227. PMID:23788759.

Conclusion Dutch women about to participate in the screening programme can be reassured that the chance of false-positive recall in the Netherlands is relatively low. A new screening policy and improved mammography have increased the detection of an early screening carcinoma and lowering the risk of interval carcinoma.


Nota bibliográfica cribado c mama 2013-05

Hofvind S, Ursin G, Tretli S, Sebuødegård S, Møller B. Breast cancer mortality in participants of the Norwegian Breast Cancer Screening Program. Cancer 2013:n/a-n/a.  DOI:10.1002/cncr.28174.
CONCLUSIONS After 15 years of follow-up, a 43% reduction in mortality was observed among women who attended the national mammographic screening program in Norway. Cancer 2013. © 2013 American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Cancer 2013. © 2013 American Cancer Society.

Miller AB. Overdiagnosis of breast cancer. (editorial). International Journal of Cancer 2013:n/a-n/a. DOI:10.1002/ijc.28258.

Falk RS, Hofvind S, Skaane P, Haldorsen T. Overdiagnosis among women attending a population-based mammography screening program. International Journal of Cancer 2013;133(3):705-712. DOI:10.1002/ijc.28052.
Increased incidence of ductal carcinoma in situ (DCIS) and invasive breast cancer (IBC) after introduction of organized screening has prompted debate about overdiagnosis. The aim was to examine the excess in incidence of DCIS and IBC during the screening period and the deficit after women left the program, and thereby to estimate the proportion of overdiagnosis. Women invited to the Norwegian Breast Cancer Screening Program were analyzed for DCIS or IBC during the period 1995?2009. Incidence rate ratios (IRRs) were calculated for attended vs. never attended women. The IRRs were adjusted by Mantel-Haenszel (MH) method and applied to a set of reference rates and a reference population to estimate the proportion of overdiagnosis during the women's lifespan after the age of 50 years. A total of 702,131 women were invited to the program. An excess of DCIS and IBC was observed among women who attended screening during the screening period; prevalently invited women aged 50?51 years had a MH IRR of 1.86 (95% CI 1.65?2.09) and subsequently invited women aged 52?69 years had a MH IRR of 1.56 (95% CI 1.45?1.68). In women aged 70?79 years, a deficit of 30% (MH IRR 0.70, 95% CI 0.62?0.80) was observed 1?10 years after they left the screening program. The estimated proportion of overdiagnosis varied from 10 to 20% depending on outcome and whether the women were invited or actually screened. The results highlight the need for individual data with longitudinal screening history and long-term follow-up as a basis for estimating overdiagnosis.

Zahl P, Suhrke P, Jørgensen KJ. Overdiagnosis of breast cancer in Norway: What have the authors adjusted for? (letter). International Journal of Cancer 2013:n/a-n/a. DOI:10.1002/ijc.28248.

Falk RS, Hofvind S, Skaane P, Haldorsen T. Response to comments by Kalager et al. and Zahl et al. (carta). International Journal of Cancer 2013:n/a-n/a. DOI:10.1002/ijc.28247.

Kalager M, Løberg M, Fønnebø VM, Bretthauer M. Failure to account for selection-bias. (carta). International Journal of Cancer 2013:n/a-n/a. DOI:10.1002/ijc.28244.

Baum M. The Marmot report: accepting the poisoned chalice. (editorial). Br J Cancer 2013 06/06Enlace:

Houssami N, Skaane P. Overview of the evidence on digital breast tomosynthesis in breast cancer detection. Breast 2013 Apr;22(2):101-108.
 DOI:10.1016/j.breast.2013.01.017; PMID:23422255.
Digital breast tomosynthesis (DBT, or 3D-mammography), a three-dimensional derivative of digital mammography (DM), reduces the effect of tissue superimposition and may improve mammographic interpretation. In this review, we examined the evidence on the accuracy of DBT in clinical studies. Published studies of DBT were relatively small studies, mostly test-set observer (reader) studies or clinical series that included symptomatic and screen-recalled cases, and were generally enriched with cancers. With these limitations in mind, the evidence showed some consistent findings, summarized as follows: two-view DBT has at least equal or better accuracy than standard two-view DM, whereas one-view DBT does not have better accuracy than standard DM; the addition of DBT to standard mammography (for mammographic interpretation or for assessment or triage of screen-recalled abnormalities) increases accuracy; improved accuracy from using DBT (relative to, or added to, DM) may be due to increased cancer detection or due to reduced false positive recalls, or both; and subjective interpretation of cancer conspicuity consistently found that cancers were equally or more conspicuous on DBT relative to DM. Preliminary data from population screening trials suggest that the integration of DBT with conventional DM (screen-reading using combined 2D + 3D mammography) may substantially improve breast cancer detection, although final results are not yet available, and many logistical issues need further evaluation to determine the potential implications and cost of combined 2D + 3D mammographic screening. At present, there is insufficient evidence to justify a change from standard DM to DBT however the available data strongly support investment in new large-scale population screening trials. These trials need to avoid the 'double' acquisitions required for 2D + 3D mammograms, and should therefore focus on evaluating integrated 2Dsynthetic + 3D mammography (where 2D-images are reconstructed from the DBT acquisition), and should consider using a randomized design.

Dourado F, Carreira H, Lunet N. Mammography use for breast cancer screening in Portugal: results from the 2005/2006 National Health Survey. The European Journal of Public Health 2013 June 01;23(3):386-392.


Nota bibliográfica cribado c mama 2013-04

Carney P, O'Neill S, O'Neill C. Determinants of breast cancer screening uptake in women, evidence from the British Household Panel Survey. Soc Sci Med 2013 Apr;82:108-114. DOI:10.1016/j.socscimed.2012.12.018; 10.1016/j.socscimed.2012.12.018. PMID:23415458.

Breast cancer screening is an integral part of the cancer control strategies of many developed economies. In Britain individuals screened in a given year are re-called every three years unless results indicate a need for more immediate investigation. This pattern may create a legacy arising from past decisions, a legacy that should be considered when examining current decisions. In this paper we use a balanced panel drawn from the British Household Panel Survey of 1997 women over an 18 year period to examine variations in uptake. A dynamic random effects probit model is used to control for unobserved heterogeneity and the legacy of previous decisions. As might be expected women to whom universal screening is offered are more likely to screen than others. Changes during the study period in the eligible age range saw an increase in uptake among the age group to whom the programme was extended but not among other groups. Past screening behaviour was found to be a significant predictor of current behaviour. Failure to account for past choices may result in model mis-specification and a failure to develop policies aimed at promoting initial engagement that may compromise the screening programme. Income was not found to be a significant determinant of uptake.

Amaro J, Severo M, Vilela S, Fonseca S, Fontes F, La Vecchia C, et al. Patterns of breast cancer mortality trends in Europe. The Breast 2013 6;22(3):244-253.
Conclusion This study provides a general model for the description and interpretation of the variation in breast cancer mortality in Europe, based in three main patterns.

Eric Lavigne, Eric J Holowaty, Sai Yi Pan, Paul J Villeneuve, Kenneth C Johnson, Dean A Fergusson, et al. Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta-analysis of observational studies. BMJ 2013 BMJ Publishing Group Ltd;346 DOI:10.1136/bmj.f2399.
Conclusions The research published to date suggests that cosmetic breast augmentation adversely affects the survival of women who are subsequently diagnosed as having breast cancer. These findings should be interpreted with caution, as some studies included in the meta-analysis on survival did not adjust for potential confounders. Further investigations are warranted regarding diagnosis and prognosis of breast cancer among women with breast implants.

Houssami N, Abraham LA, Kerlikowske K, Buist DSM, Irwig L, Lee J, et al. Risk Factors for Second Screen-Detected or Interval Breast Cancers in Women with a Personal History of Breast Cancer Participating in Mammography Screening. Cancer Epidemiology Biomarkers & Prevention 2013 March 19 DOI:10.1158/1055-9965.EPI-12-1208-T.
Conclusion: Although the risk of a second breast cancer is modest, our models identify risk factors for interval second breast cancer in PHBC women.Impact: Our findings may guide discussion and evaluations of tailored breast screening in PHBC women, and incorporating this information into clinical decision-making warrants further research. Cancer Epidemiol Biomarkers Prev; 1–16. ©2013 AACR.

Mandelblatt J, van Ravesteyn N, Schechter C, Chang Y, Huang A, Near AM, et al. Which strategies reduce breast cancer mortality most? Cancer 2013:n/a-n/a. DOI:10.1002/cncr.28087.

Foca F, Mancini S, Bucchi L, Puliti D, Zappa M, Naldoni C, et al. Decreasing incidence of late-stage breast cancer after the introduction of organized mammography screening in Italy. Cancer 2013:n/a-n/a. DOI:10.1002/cncr.28014.
CONCLUSIONS: A significant and stable decrease in the incidence of late-stage breast cancer was observed from the third year of screening onward, when the IRR varied between 0.81 and 0.71. Cancer 2013. © 2013 American Cancer Society.

Yaghjyan L, Colditz G, Rosner BA, Tamimi RM. Mammographic Breast Density and Subsequent Risk of Breast Cancer in Postmenopausal Women according to the Time Since the Mammogram. Cancer Epidemiology Biomarkers & Prevention 2013 April 19 DOI:10.1158/1055-9965.EPI-13-0169.

Conclusions. Patterns of the associations between percent density, absolute dense and non-dense area with breast cancer risk persist for up to 10 years after the mammogram. Impact. A one-time density measure can be used for long-term breast cancer risk prediction.

Nelson HD, Fu R, Goodard K, Mitchell Priest J, Okinaka-Hu L, Pappas M, et al. Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. Evidence Synthesis No. 101. AHRQ Publication No. 12-05164-EF-1. 2013.

Whelehan P, Evans A, Wells M, MacGillivray S. The effect of mammography pain on repeat participation in breast cancer screening: A systematic review. The Breast (0) DOI:10.1016/j.breast.2013.03.003.

Toriola AT, Colditz GA. Trends in breast cancer incidence and mortality in the United States: implications for prevention. Breast Cancer Res Treat 2013 Apr 2 DOI:10.1007/s10549-013-2500-7. PMID:23546552
While debate continues regarding short-term changes in breast cancer incidence and the impact of screening on mortality, a long-term view of trends in incidence and mortality may better inform our understanding of the changing patterns of disease and ultimately guide in population-based prevention. Although many factors have influenced breast cancer incidence over the past seven decades, some have played more prominent roles at various times. Changing reproductive patterns, greater longevity, and post-menopausal hormone (estrogen + progesterone) were important in the steady increase before 1980, while mammographic screening, probably in conjunction with escalating combined estrogen + progesterone use, played dominant roles in the post-1980 surge. Accruing evidence also indicates that the rapid drop in 2003 was mostly due to a sharp decline in estrogen + progesterone use. The most paradoxical observation relates to the divergence in incidence and mortality trends most noticeable when mortality rates started to decline shortly after the surge in incidence rates started in 1980. In addition to the dynamic changes in risk factor profiles, the divergence reflects wider uptake of screening mammography, better characterization of tumor biology, and improvements in treatment. The rise in incidence rates over the past three decades is due to an increase in estrogen receptor positive (ER+) tumors, which respond favorably to treatment. On the other hand, the incidence of estrogen receptor negative (ER-) tumors, which respond poorly to hormonal therapy, has been decreasing for almost three decades. Furthermore, widespread adoption of screening mammography has led to tumors being diagnosed at earlier stages when treatment is effective and advances in treatment have ensured adoption of targeted and better tolerated therapies. To achieve long-term success in the primary prevention of breast cancer, a greater understanding of factors responsible for the decrease in ER- tumors is essential. In addition, improving the sensitivity of breast cancer screening to facilitate earlier detection of tumors with very aggressive phenotypes would go a long way in bridging the divergence between incidence and mortality.


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