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Breast cancer Screening

Breast cancer Screening. NHS Breast Screening Programme NHSBSP Publication No. 61. Feb 2006 www.cancerscreening.nhs.uk. NHS Breast Screening Programme (NHSBSP) began in 1988 Aims to invite all women aged 50-70 years once every 3 years

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Breast cancer Screening

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  1. Breast cancerScreening

  2. NHS Breast Screening ProgrammeNHSBSP Publication No. 61. Feb 2006www.cancerscreening.nhs.uk • NHS Breast Screening Programme (NHSBSP) began in 1988 • Aims to invite all women aged 50-70 years once every 3 years • Number of breast cancer registrations has increased by almost 50% since NHSBSP began • Cancers detected by screening are smaller and mastectomy is less likely • NHSBSP plus earlier symptomatic presentation and greater use of adjuvant therapy has reduced mortality from breast cancer • Mammography screening trials show a 25% relative risk reduction in mortality (ITT), equates to 35% in women regularly screened • NHSBSP saves an estimated 1400 lives each year in England.

  3. Benefits vs. harms of screeningNHSBSP Publication No. 61. Feb 2006 • About 1 in 400 women regularly screened over a 10 year period will be prevented from dying from breast cancer • About 1 in 8 women regularly screened will be recalled for further tests over a 10-year period • Breast cancer will be diagnosed in only a few of these • Delicate balance between reducing recall rates so far that small cancers are missed and calling back too many women causing anxiety and possibly reducing re-attendance • Among women routinely screened and diagnosed with breast cancer: • 1 in 8 fewer women will die than would have done if they’d not been screened • 1 in 8 spared mastectomy • 1 in 8 women have a cancer detected (and treated) which would not have affected her had she not been screened.

  4. NHSBSP Publication No. 61. Feb 2006 Positive predictive value (PPV) of abnormal mammogram = 19% i.e. 19% of people with abnormal mammogram have breast cancer

  5. Overdiagnosis in breast cancer screening (1)Jorgensen KJ, Gøtzsche PC. BMJ 2009;339:b2587Welch HG. BMJ 2009;339:b1425; MeReC Rapid Review Blog No. 417 • From meta-analysis, the total overdiagnosis of breast cancer in publicly available mammography screening programmes was estimated as 52% (95%CI 46% to 58%) i.e. about one in three cancers is overdiagnosed • For every 1000 women (>50 years) who are screened for breast cancer annually for 10 years: • 1 woman will avoid dying from breast cancer • 2 to 10 women will be overdiagnosed and treated needlessly • 10 to 15 women will be told they have breast cancer earlier than they would otherwise have been told, but this will not affect their prognosis • 100 to 500 women will have at least one ‘false alarm’ (approximately half these women will undergo a biopsy). The absolute risks and benefits of breast cancer screening, including the level of overdiagnosis, should be communicated to women in a balanced way so they can make an informed decision to have screening or not.

  6. Overdiagnosis in breast cancer screening (2)Welch HG. BMJ 2009;339:b1425 ‘Mammography is one of medicine’s ‘close calls’ — a delicate balance between benefits and harms — where different people in the same situation might reasonably make different choices.’ ‘Mammography undoubtedly helps some women but hurts others. No right answer exists, instead it is a personal choice.’

  7. Summary • Breast cancer screening contributes to the falling mortality from the disease • About 1 in 400 women regularly screened over a 10-year period will be prevented from dying from breast cancer • 1 in 8 women diagnosed with breast cancer avoids a mastectomy she would have needed, had she not had the cancer diagnosed by screening • The benefits must be weighed against the harms • About 1 in 8 women regularly screened will be recalled for further assessment over a 10-year period, but very few of these have the disease • 1 in 8 women screened and diagnosed have a cancer which would not have affected her had she not been screened.

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