Breast cancer screening halves the risk of breast cancer death: a case-referent study.
Large-scale epidemiologic studies have consistently demonstrated the effectiveness of mammographic screening programs, however the benefits are still subject to debate. We estimated the effect of the Dutch screening program on breast cancer mortality. In a large multi-region case-referent study, we identified all breast cancer deaths in 2004 and 2005 in women aged 50-75 who had been invited for screening (cases). Cases were individually matched to referents from the population invited to screening. Conditional logistic regression was used to estimate the odds ratio (OR) of breast cancer death according to individual screening history. The OR was adjusted for self-selection bias using regional correction factors for the difference in baseline risk for breast cancer death between screened and unscreened women. A total of 1233 cases and 2090 referents were included in this study. We found a 58% reduction in breast cancer mortality in screened versus unscreened women (adjusted OR = 0.42, 95% CI 0.33-0.53). Screening, i.e. early detection and treatment, has resulted in a substantial reduction in breast cancer mortality, indicating that the Dutch breast cancer screening program is highly effective.
Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands.
Ellen
E
Paap
Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
André L M
AL
Verbeek
Comprehensive Cancer Centre the Netherlands, Utrecht, The Netherlands.
Anita A M
AA
Botterweck
Comprehensive Cancer Centre the Netherlands, Utrecht, The Netherlands.
Heidi J
HJ
van Doorne-Nagtegaal
Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands; Screening Program Early Detection of Breast Cancer in the Eastern Part of the Netherlands, Nijmegen, The Netherlands.
Mechli
M
Imhof-Tas
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Harry J
HJ
de Koning
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Suzie J
SJ
Otto
Comprehensive Cancer Centre the Netherlands, Utrecht, The Netherlands.
Linda
L
de Munck
Screening Program Early Detection of Breast Cancer in the South-West Part of the Netherlands, Vlaardingen, The Netherlands.
Annemieke
A
van der Steen
National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands.
Roland
R
Holland
National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands; Department of Radiology, Academic Medical Centre, University of Amsterdam, The Netherlands.
Gerard J
GJ
den Heeten
Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands. Electronic address: mireille.broeders@radboudumc.nl.
Mireille J M
MJ
Broeders
D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality*; D016022:Case-Control Studies; D055088:Early Detection of Cancer / Q000401:mortality*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008327:Mammography; D008875:Middle Aged
Breast cancer; Case-referent study; Effectiveness; Mammography; Screening