programas cribado cancer

Nota bibliográfica cribado c mama 2014-04

Paap E, Verbeek ALM, Botterweck AAM, van Doorne-Nagtegaal HJ, Imhof-Tas M, de Koning HJ, et al. Breast cancer screening halves the risk of breast cancer death: A case-referent study. Breast. 2014;(0).
 Available from: doi:
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.

Hill C. Dépistage du cancer du sein. Presse Med. 2014;(0). Available from:    doi:

Breast cancerscreeningisthesubjectofavigorousdebate. This concerns both the estimation of the benefit derived from mammographic screening, i.e.the breast cancer mortality reduction associated with screening, and the estimation of overdiagnosis, which is the detection of a breast cancer that would never have become symptomatic during the lifetime of  the woman. The overview of al ltrials gives an estimation of 20% for the breast  cancer mortality reduction in the population invited to screening and of 30% in the population effectively screened. Estimating overdiagnosis is more difficult and many estimations are biased for want of a proper adjustment to correct for systematic differences between the compared populations. None of the correctly adjusted estimations are above 10%. Breast cancer screening is more beneficial than detrimental, but the benefit is not large. A woman who refuses breast cancer screening is less unreasonable than a woman who continues to smoke since tobacco kills half of regular smokers.

Houssami N, Macaskill P, Bernardi D, Caumo F, Pellegrini M, Brunelli S, et al. Breast screening using 2D-mammography or integrating digital breast tomosynthesis (3D-mammography) for single-reading or double-reading – Evidence to guide future screening strategies. Eur J Cancer. 2014; Available from: doi: 10.1016/j.ejca.2014.03.017.

PurposeWe compared detection measures for breast screening strategies comprising single-reading or double-reading using standard 2D-mammography or 2D/3D-mammography, based on the ?screening with tomosynthesis or standard mammography? (STORM) trial.

Bhoo-Pathy N, Subramaniam S, Taib NA, Hartman M, Alias Z, Tan G-H, et al. Spectrum of very early breast cancer in a setting without organised screening. Br J Cancer. 2014;110(9):2187–94. Available from:

Conclusions: The proportion of women presenting with very early breast cancer in this setting without organised screening is increasing. These women seem to survive just as well as their counterparts from affluent settings.

Walter L, Schonberg M. Screening mammography in older women: A review. JAMA. 2014;311(13):1336–47. Available from:

Conclusions and Relevance. For women with less than a 10-year life expectancy, recommendations to stop screening mammography should emphasize increased potential harms from screening and highlight health promotion measures likely to be beneficial over the short term. For women with a life expectancy of more than 10 years, deciding whether potential benefits of screening outweigh harms becomes a value judgment for patients, requiring a realistic understanding of screening outcomes.

Pace L, Keating N. A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA. 2014;311(13):1327–35. Available from:
Conclusions and Relevance To maximize the benefit of mammography screening, decisions should be individualized based on patients’ risk profiles and preferences. Risk models and decision aids are useful tools, but more research is needed to optimize these and to further quantify overdiagnosis. Research should also explore other breast cancer screening strategies.

Ceugnart L, Taïeb S, Deghaye M. Controverses sur le dépistage du cancer du sein par mammographie : quelles informations donner aux femmes ? Imag la Femme. 2014; Available from: doi: 10.1016/j.femme.2014.03.005.

Le dépistage par mammographie du cancer du sein fait l’objet depuis plusieurs années de controverses sur son efficacité en termes de diminution de la mortalité spécifique, des faux positifs et du surdiagnostic induit. L’analyse de la littérature récente et notamment des revues indépendantes montre que cette action de santé publique a un impact positif permettant une diminution de la mortalité spécifique de 20 % environ au prix d’un surdiagnostic évalué entre 5 et 11 %. Les bénéfices du dépistage mammographique sont donc significatifs mais il convient de donner aux femmes une information complète et loyale sur les effets indésirables que comporte toute intervention dans le domaine médical (faux positifs, faux négatifs, surdiagnostic et exposition aux rayonnements ionisants). Controversies about breast cancer screening are frequent for a long time. The most important criticisms are again effectiveness in terms of breast cancer mortality, false positive results and overdiagnosis. Recent publications including independent review shows that mammographic screening decreases breast cancer mortality from 20% and that overdiagnosis is estimated between 5 to 11%. The benefits of breast cancer screening are significant but we need to give complete information about adverse effects that include false positive, false negative, overdiagnosis and ionizing radiation exposure.

Baines CJ. Rational and irrational issues in breast cancer screening. Cancers 2011;3(1):252–66. Available from: doi: 10.3390/cancers3010252. PMID: 24212617.

Evidence on the efficacy of breast screening from randomized controlled trials conducted in the last decades of the 1900s is reviewed. For decades, controversy about their results has centered on the magnitude of benefit in terms of breast cancer mortality reduction that can be achieved. However more recently, several expert bodies have estimated the benefits to be smaller than initially expected and concerns have been raised about screening consequences such as over-diagnosis and unnecessary treatment. Trials with substantial mortality reduction have been lauded and others with null effects have been critiqued. Critiques of the Canadian National Breast Screening Study are refuted. Extreme responses by screening advocates to the United States Preventive Services Task Force 2009 guidelines are described. The role vested interests play in determining health policy is clearly revealed in the response to the guidelines and should be more generally known. A general reluctance to explore unexpected results or to accept new paradigms is briefly discussed.

Lee CI, Elmore JG. Increasing Value by Increasing Volume: Call for Changes in US Breast Cancer Screening Practices. J Natl Cancer Inst. 2014;106(3). Available from: doi: 10.1093/jnci/dju028.

Théberge I, Chang S-L, Vandal N, Daigle J-M, Guertin M-H, Pelletier É, et al. Radiologist Interpretive Volume and Breast Cancer Screening Accuracy in a Canadian Organized Screening Program. J Natl Cancer Inst. 2014;106(3). Available from: doi: 10.1093/jnci/djt461.

Conclusions The minimum annual volume of 500 mammograms required in North America is justified; radiologist accuracy may be compromised if interpretive volume is consistently less than this requirement. Raising interpretive volume may help to reduce the frequency of false positives without loss of sensitivity. Possible gains in accuracy may be greater with increases in volume of up to approximately 3000 mammograms interpreted annually.

Gigerenzer G. Breast cancer screening pamphlets mislead women. BMJ. 2014;348. Available from:
 All women and women’s organisations should tear up the pink ribbons and campaign for honest information.
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