programas cribado cancer

Nota bibliográfica cribado c mama 2014-06

Bolton KC, Mace JL, Vacek PM, Herschorn SD, James TA, Tice JA, et al. Changes in Breast Cancer Risk Distribution Among Vermont Women Using Screening Mammography. J Natl Cancer Inst. 2014;106(8).
 Available from: doi: 10.1093/jnci/dju157.

Conclusions The observed decline in women screened in Vermont in recent years is largely attributable to reductions in screening visits by women who are at low risk of developing breast cancer.

Smith RA. The Value of Modern Mammography Screening in the Control of Breast Cancer: Understanding the Underpinnings of the Current Debates. Cancer Epidemiol Biomarkers Prev. 2014;23(7):1139–46. Available from: doi: 10.1158/1055-9965.EPI-13-0946.

Since the introduction of mammography screening, debates about the value of screening have endured and been contentious. Recent reviews of the randomized controlled trials reach different conclusions about the absolute benefit of screening, as do evaluations of population trends in breast cancer mortality and the evaluations of service screening. Conclusions about the value of screening commonly are expressed in terms of the balance of benefits and harms, which can differ greatly even when derived seemingly from the same data. It can be shown when different estimates are adjusted to a common screening and follow-up scenario, differences in balance sheet estimates diminish substantially. The strong evidence of benefit associated with exposure to modern mammography screening suggests that it is time to move beyond the randomized controlled trial estimates of benefit and consider policy decisions on the basis of benefits and harms estimated from the evaluation of current screening programs.

Paci E, Broeders M, Hofvind S, Puliti D, Duffy SW, Group the EW. European Breast Cancer Service Screening Outcomes: A First Balance Sheet of the Benefits and Harms. Cancer Epidemiol Biomarkers Prev. 2014;23(7):1159–63.
 Available from: doi: 10.1158/1055-9965.EPI-13-0320.

A recent comprehensive review has been carried out to quantify the benefits and harms of the European population-based mammographic screening programs. Five literature reviews were conducted on the basis of the observational published studies evaluating breast cancer mortality reduction, breast cancer overdiagnosis, and false-positive results. On the basis of the studies reviewed, the authors present a first estimate of the benefit and harm balance sheet. For every 1,000 women screened biennially from ages 50 to 51 years until ages 68 to 69 years and followed up until age 79 years, an estimated seven to nine breast cancer deaths are avoided, four cases are overdiagnosed, 170 women have at least one recall followed by noninvasive assessment with a negative result, and 30 women have at least one recall followed by invasive procedures yielding a negative result. The chance of a breast cancer death being avoided by population-based mammography screening of appropriate quality is more than that of overdiagnosis by screening. These outcomes should be communicated to women offered service screening in Europe.

Coyle C, Kinnear H, Rosato M, Mairs A, Hall C, O’Reilly D. Do women who intermittently attend breast screening differ from those who attend every invitation and those who never attend? J Med Screen. 2014;21(2):98–103.
Available from: doi: 10.1177/0969141314533677.

Conclusions One-time attenders are an important and distinct subgroup of screening invitees in this analysis. Their distinct characteristics suggest that transitory factors, such as change in marital status, ill-health, or addressing difficulties through change of residence are important. These distinct characteristics suggest the need for different approaches to increase attendance, among both intermittent attenders and those not attending at all.

Kopans DB, Webb ML, Cady B. The 20-year effort to reduce access to mammography screening: Historical facts dispute a commentary in Cancer. Cancer. 2014;n/a–n/a. Available from: doi: 10.1002/cncr.28791.

Mammography screening fulfills all requirements for an effective screening test. It detects many cancers earlier when they are at a smaller size and earlier stage, and it has been demonstrated that this reduces breast cancer deaths in randomized controlled trials. When screening is introduced into the population, the death rate from breast cancer declines. Nevertheless, scientifically unsupported arguments that appear in the medical literature are passed on to the public and continue to confuse women and physicians regarding the value of screening. Methodologically flawed challenges to mammography have been almost continuous since the 1990s. And, as each challenge has been invalidated, a new, specious challenge has been raised. The authors of this report address the long history of misinformation that has developed in the effort to reduce access to screening, and they address the issues raised by commentators concerning their recent publication in this journal.

Friedewald SM, Rafferty  EA, Rose SL, et al.. Breast cancer screening using tomosynthesisin combination with digital mammography. JAMA. 2014;311(24):2499–507. Available from:

Conclusions and Relevance Addition of tomosynthesis to digital mammography was associated with a decrease in recall rate and an increase in cancer detection rate. Further studies are needed to assess the relationship to clinical outcomes.

Duffy SW. Recent results from the two Canadian Breast Screening Trials. J Med Screen. 2014;21(2):59–60. Available from: doi: 10.1177/0969141314537615.
Weedon-Fekjær H, Romundstad PR, Vatten LJ. Modern mammography screening and breast cancer mortality: population study. BMJ. 2014;348. Available from:

Conclusion Invitation to modern mammography screening may reduce deaths from breast cancer by about 28%.

Elmore JG, Harris RP. The harms and benefits of modern screening mammography (editorial). BMJ. 2014;348. Available from:

José Bento M, Gonçalves G, Aguiar A, Antunes L, Veloso V, Rodrigues V. Clinicopathological differences between interval and screen-detected breast cancers diagnosed within a screening programme in Northern Portugal. J Med Screen. 2014;21(2):104–9. Available from: doi: 10.1177/0969141314534406.

Conclusion Our results are consistent with other studies. IC’s have a more aggressive biology than SDs. Our findings did not show any unexpected pattern requiring changes to our screening procedures, but continuous identification and characterization of IC is advisable.

Brawley OW. Breast Cancer Screening. Time for Rational Discourse (editorial). Cancer. 2014;(Published online Month 00, 2014):4–6. Available from: doi: 10.1002/cncr.28788.

Berry DA. Failure of Researchers , Reviewers , Editors , and the Media to Understand Flaws in Cancer Screening Studies. Cancer. 2014;(Article first published online: 12 JUN 2014):1–8. doi: 10.1002/cncr.28795.

Observational studies present inferential challenges. These challenges are acute in cancer screening studies, in which lead-time and length biases are ever present. These biases can make any study worthless. Moreover, a flawed study’s impact on the public can be deleterious when its conclusions are publicized by a naïve media. Flawed studies can also make the public learn to be wary of any article or reports of articles claiming to be scientific. Here, the author addresses these and related issues in the context of a study published in Cancer.

Pisano ED, Yaffe MJ. Breast cancer screening: Should tomosynthesis replace digital mammography? [editorial] JAMA. 2014;311(24):2488–9. Available from:

Printz C. Mammogram debate flares up: Latest breast cancer screening study fuels controversy. Cancer. 2014;120(12):1755–6. Available from: doi: 10.1002/cncr.28803.

Cheddad A, Czene K, Shepherd JA, Li J, Hall P, Humphreys K. Enhancement of Mammographic Density Measures in Breast Cancer Risk Prediction. Cancer Epidemiol Biomarkers Prev. 2014;23(7):1314–23. Available from: doi: 10.1158/1055-9965.EPI-13-1240.

Conclusions: MIP is a marker of volumetric density that can be used to complement area PD in mammographic density studies and breast cancer risk assessment.Impact: Inclusion of MIP in risk models should be considered for studies using area PD from analog films. Cancer Epidemiol Biomarkers Prev; 23(7); 1314–23.

Webb M, Cady B, Michaelson J. A failure analysis of invasive breast cancer. Cancer. 2013;1–8. Available from: doi: 10.1002/cncr.28199.

CONCLUSIONS Most deaths from breast cancer occur in unscreened women. To maximize mortality reduction and life-years gained, initiation of regular screening before age 50 years should be encouraged.
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