Measuring the mortality impact of breast cancer screening.
OBJECTIVE
To i) estimate how large the mortality reductions would be if women were offered screening from age 50 until age 69; ii) to do so using the same trials and participation rates considered by the Canadian Task Force; iii) but to be guided in our analyses by the critical differences between cancer screening and therapeutics, by the time-pattern that characterizes the mortality reductions produced by a limited number of screens, and by the year-by-year mortality data in the appropriate segment of follow-up within each trial; and thereby iv) to avoid the serious underestimates that stem from including inappropriate segments of follow-up, i.e., too soon after study entry and too late after discontinuation of screening.


METHODS
We focused on yearly mortality rate ratios in the follow-up years where, based on the screening regimen employed, mortality deficits would be expected. Because the regimens differed from trial to trial, we did not aggregate the yearly data across trials. To avoid statistical extremes arising from the small numbers of yearly deaths in each trial, we calculated rate ratios for 3-year moving windows.


RESULTS
We were able to extract year-specific data from the reports of five of the trials. The data are limited for the most part by the few rounds of screening. Nevertheless, they suggest that screening from age 50 until age 69 would, at each age from 55 to 74, result in breast cancer mortality reductions much larger than the estimate of 21% that the Canadian Task Force report is based on.


CONCLUSIONS
By ignoring key features of cancer screening, several of the contemporary analyses have seriously underestimated the impact to be expected from such a program of breast cancer screening.
McGill University. james.hanley@mcgill.ca.
James A
JA
Hanley
Maurice
M
McGregor
Zhihui
Z
Liu
Erin C
EC
Strumpf
Nandini
N
Dendukuri
D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality*; D002170:Canada / Q000453:epidemiology; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate
Cancer screening; early diagnosis; mortality; randomized trials