[Clear-cut beneficial effect of breast cancer screening on the trend in breast-conserving surgery].
Since the introduction of mammographic screening, controversies have emerged concerning its effect on mortality as well as on the management of breast cancer. A Dutch population-based study demonstrates a significant difference between screening-detected breast cancers and non-screening-detected breast cancers in terms of smaller tumour size, more favourable nodal status and a 14% increase (difference between percentages) in breast-conserving surgery in favour of the screening-detected group. However, since no overall increase in the rate of breast-conserving therapy was found, the authors concluded that the impact of screening on surgical management was limited. An alternative explanation is that during the 1990s, the indications for breast-conserving surgery have become more restrictive in terms of tumour-free margins. Other investigators have demonstrated similar increases in the rate of breast-conserving surgery in screening-detected breast cancer patients. Although the debate on mammographic screening has definitely not reached its conclusion, Swedish data available clearly demonstrate a decrease in breast cancer mortality (21%) due to mammographic screening, which is contrary to recent criticism.
van der Hage
J A
JA
Leids Universitair Medisch Centrum, afd. Chirurgie, Postbus 9600, 2300 RC Leiden.
van de Velde
C J H
CJ
D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards*; D008403:Mass Screening; D015412:Mastectomy, Segmental / Q000639:trends*; D009426:Netherlands
Wel degelijk gunstig effect van borstkankerscreening op de trend in mammasparende chirurgie.