title: Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database.
abstract: OBJECTIVE
  To compare trends in breast cancer mortality within three pairs of neighbouring European countries in relation to implementation of screening.
  
  
  METHODS
  Retrospective trend analysis.
  
  
  METHODS
  Three country pairs (Northern Ireland (United Kingdom) v Republic of Ireland, the Netherlands v Belgium and Flanders (Belgian region south of the Netherlands), and Sweden v Norway).
  
  
  METHODS
  WHO mortality database on cause of death and data sources on mammography screening, cancer treatment, and risk factors for breast cancer mortality.
  
  
  METHODS
  Changes in breast cancer mortality calculated from linear regressions of log transformed, age adjusted death rates. Joinpoint analysis was used to identify the year when trends in mortality for all ages began to change.
  
  
  RESULTS
  From 1989 to 2006, deaths from breast cancer decreased by 29% in Northern Ireland and by 26% in the Republic of Ireland; by 25% in the Netherlands and by 20% in Belgium and 25% in Flanders; and by 16% in Sweden and by 24% in Norway. The time trend and year of downward inflexion were similar between Northern Ireland and the Republic of Ireland and between the Netherlands and Flanders. In Sweden, mortality rates have steadily decreased since 1972, with no downward inflexion until 2006. Countries of each pair had similar healthcare services and prevalence of risk factors for breast cancer mortality but differing implementation of mammography screening, with a gap of about 10-15 years.
  
  
  CONCLUSIONS
  The contrast between the time differences in implementation of mammography screening and the similarity in reductions in mortality between the country pairs suggest that screening did not play a direct part in the reductions in breast cancer mortality.
authors.affiliation: International Prevention Research Institute, 95 Cours Lafayette, 69006 Lyon, France. philippe.autier@i-pri.org
authors.forename: Philippe
authors.initials: P
authors.lastname: Autier
authors.forename: Mathieu
authors.initials: M
authors.lastname: Boniol
authors.forename: Anna
authors.initials: A
authors.lastname: Gavin
authors.forename: Lars J
authors.initials: LJ
authors.lastname: Vatten
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality*; D002423:Cause of Death; D015986:Confounding Factors, Epidemiologic; D055088:Early Detection of Cancer / Q000379:methods / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008327:Mammography / Q000401:mortality; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009765:Obesity / Q000401:mortality; D015995:Prevalence; D011379:Prognosis