programas cribado cancer


Nota Bibliográfica

Esta Nota es una recopilación de publicaciones (artículos, informes, libros) sobre cribado de cáncer resultado de una revisión no sistemática de la literatura.

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Josep A Espinás. Pla Director d'Oncología de Catalunya.
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Nota bibliográfica cribado c mama 2013-10

Apesteguía Ciriza L, Pina Insausti LJ. Cribado poblacional de cáncer de mama. Certezas, controversias y perspectivas de futuro. Radiologia. (0). Available from: doi:

Resumen Los programas poblacionales de detección precoz del cáncer de mama basados en la mamografía deben mantener un alto nivel de calidad y sus resultados han de ser permanentemente monitorizados. Aunque la mayoría de autores consideran que estos programas han disminuido la mortalidad por cáncer de mama aproximadamente un 30%, no faltan voces críticas. Algunos autores sostienen que la reducción de la mortalidad es inferior, aproximadamente del 12%, por errores en la aleatorización de pacientes, porque la tasa de tumores avanzados apenas ha disminuido y porque los tratamientos adyuvantes también mejoran la supervivencia. Otras críticas se centran también en el sobrediagnóstico y el sobretratamiento. Creemos que a pesar del indudable valor del cribado mamográfico, debemos estar abiertos a ciertos cambios, como la estratificación de las pacientes por nivel de riesgo y la introducción de técnicas complementarias a la mamografía, como la tomosíntesis, la ecografía y la resonancia magnética en casos seleccionados

Nederend J, Duijm LEM, Louwman MWJ, Coebergh JW, Roumen RMH, Lohle PN, et al. Impact of the transition from screen-film to digital screening mammography on interval cancer characteristics and treatment – A population based study from the Netherlands. Eur J Cancer. 2013;
Available from: doi: 10.1016/j.ejca.2013.09.018.

Ozanne EM. Overdiagnosis and Overtreatment of Breast Cancer: How Can We Promote Informed Patient Choice? Curr Breast Cancer Rep. 2013; Available from: doi: 10.1007/s12609-013-0128-6.

Gur D, Sumkin JH. Screening for Early Detection of Breast Cancer: Overdiagnosis versus Suboptimal Patient Management. Radiology. 2013;268(2):327–8. Available from: doi: 10.1148/radiol.13122721.     PMID: 23882095.

Wickerham DL, Julian TB. Ductal Carcinoma In Situ: A Rose by Any Other Name. J Natl Cancer Inst. 2013;
Available from:
doi: 10.1093/jnci/djt268.

Punglia RS, Schnitt SJ, Weeks JC. Treatment of Ductal Carcinoma In Situ After Excision: Would a Prophylactic Paradigm Be More Appropriate? J Natl Cancer Inst. 2013; Available from: doi: 10.1093/jnci/djt256.

Corresponding to the increased use of mammography, the incidence of ductal carcinoma in situ (DCIS) has risen dramatically in the past 30 years. Despite its growing incidence, the treatment of DCIS remains highly variable and controversial. Although DCIS itself does not metastasize and is never lethal, it may be a precursor of invasive breast cancer and is a marker of increased breast cancer risk. Confusing a precursor lesion with cancer, many clinicians apply an invasive breast cancer treatment paradigm to DCIS patients, offering adjuvant radiation therapy and tamoxifen after diagnosis. In this commentary, we outline the issues associated with DCIS management—is DCIS a cancer, a precursor of cancer, or a marker of invasive carcinoma risk? Specifically, we argue that consideration be given to removing the term “carcinoma” from DCIS, using cancer “occurrence” to mean the diagnosis of invasive cancer after DCIS instead of “recurrence,” and make the argument that a prophylactic paradigm of treatment after excision may be more appropriate.
Marmot MG, Altman DG, Cameron D a, Dewar J a, Thompson SG, Wilcox M. The benefits and harms of breast cancer screening: an independent review. Br J Cancer. 2013;108(11):2205–40. Available from: doi: 10.1038/bjc.2013.177. PMID: 23744281.

Ripping TM, Verbeek a LM, van der Waal D, Otten JDM, den Heeten GJ, Fracheboud J, et al. Immediate and delayed effects of mammographic screening on breast cancer mortality and incidence in birth cohorts. Br J Cancer. 2013;(October):1–5. Available from:
doi: 10.1038/bjc.2013.627.  PMID: 24113141.

Conclusion:When applying a trend study to estimate the impact of mammographic screening, we recommend using a birth cohort approach.British Journal of Cancer advance online publication, 10 October 2013; doi:10.1038/bjc.2013.627

Duffy SW, Chen TH, Smith RA. Real and artificial controversies in breast cancer screening. Breast Cancer Manag. 2013;2(6):519–28.
Available from:
doi: 10.2217/bmt.13.53.

SUMMARY We review the apparent disparities between different reviews of the effects of mammographic screening on mortality from breast cancer and overdiagnosis. When results of each review are expressed with respect to a common population and a common baseline, all find a substantial mortality benefit and variation among estimates is minor. There are genuine disagreements about overdiagnosis, but methods that take account of lead time and underlying incidence trends yield estimates of overdiagnosis that are modest and are outweighed by the mortality benefit. There is potential for individualized screening regimens, particularly with respect to breast density


Nota bibliográfica cribado c mama 2013-09

Njor SH, Garne JP, Lynge E. Over-diagnosis estimate from The Independent UK Panel on Breast Cancer Screening is based on unsuitable data. J Med Screen. 2013;20(2):104–5. Available from: doi: 10.1177/0969141313495190.

Paci E, Smith R, Broeders M, Duffy S. Complex statistical techniques cannot overcome weak methodology in the evaluation of breast cancer mortality trends. J R Soc Med. 2013;106(9):346.
Available from: doi: 10.1177/0141076813501807.

NICE.   Classification and care of people at risk of familial breast cancer and management of breast cancer and related risks in people with a family history of breast cancer. Manchester; 2013.

Mukhtar TK, Yeates DRG, Goldacre MJ. Breast cancer mortality trends in England and the assessment of the effectiveness of mammography screening: population-based study. J R Soc Med. 2013;106(6):234–42. Available from: doi: 10.1177/0141076813486779.
Conclusions Mortality statistics do not show an effect of mammographic screening on population-based breast cancer mortality in England.

Maxwell AJ, Beattie C, Lavelle J, Lyburn I, Sinnatamby R, Garnett S, et al. The effect of false positive breast screening examinations on subsequent attendance: retrospective cohort study. J Med Screen. 2013;20(2):91–8. Available from: doi: 10.1177/0969141313499147.
Conclusions The findings suggest that most women who undergo the breast screening assessment process retain confidence in breast screening. Needle sampling and open biopsy should be used judiciously in the assessment of screen-detected abnormalities in view of the reduced reattendance that results from their use after incident screening examinations.

Webb ML, Cady B, Michaelson JS, Bush DM, Calvillo KZ, Kopans DB, et al. A failure analysis of invasive breast cancer. Cancer. 2013;n/a–n/a. Available from: 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.

 Kerlikowske K, Zhu W, Hubbard RA, Geller B, Dittus K, Braithwaite D, et al. Outcomes of screening mammography by frequency, breast density, and postmenopausal hormone therapy. JAMA Intern Med. 2013;173(9):807–16. doi: 10.1001/jamainternmed.2013.307; 10.1001/jamainternmed.2013.307.
CONCLUSIONS AND RELEVANCE: Women aged 50 to 74 years, even those with high breast density or HT use, who undergo biennial screening mammography have similar risk of advanced-stage disease and lower cumulative risk of false-positive results than those who undergo annual mammography. When deciding whether to undergo mammography, women aged 40 to 49 years who have extremely dense breasts should be informed that annual mammography may minimize their risk of advanced-stage disease but the cumulative risk of false-positive results is h…

Omer ZB  Esserman LJ, Howe R,Ozanne EM HE. IMpact of ductal carcinoma in situ terminology on patient treatment preferences. JAMA Intern Med. 2013;-. Available from: doi: 10.1001/jamainternmed.2013.8405.
 Ductal carcinoma in situ (DCIS) is a preinvasive malignancy of the breast and is diagnosed in more than 50?000 women a year in the United States. It is treated with either mastectomy or lumpectomy, often combined with radiation therapy.1 In cases of low-grade DCIS, studies suggest that if progression occurs, it does so within a time frame of 5 to 40 years2 and possibly in only 20% of DCIS cases.3 This raises the possibility that some cases of DCIS will follow an indolent course that will not attain clinical significance during the patient's lifetime. Accordingly, watchful waiting has been proposed as a reasonable option for DCIS,4 akin to what is currently offered for patients with early stage prostate cancer; however, how to implement such a strategy is unclear.

Njor SH, von Euler-Chelpin M. Information to women invited to mammography screening. Ann Oncol. 2013;24(10):2467–8.
Available from: doi: 10.1093/annonc/mdt373.

Berry DA. Breast cancer screening: Controversy of impact. St Gall 2013 Proc B. 2013;22, Supple(0):S73–S76.
Available from: doi:
 Abstract Few medical issues have been as controversial or as political, at least in the United States as the role of mammographic screening for breast cancer. The advantages of finding a cancer early seem obvious. Indeed, randomized trials evaluating screening mammography demonstrate a reduction in breast cancer mortality, but the benefits are less than one would hope. Moreover, the randomized trials are themselves subject to criticism, including that they are irrelevant in the modern era because most were conducted before chemotherapy and hormonal therapy became widely used. In this article I chronicle the evidence and controversies regarding mammographic screening, including attempts to assess the relative contributions of screening and therapy in the substantial decreases in breast cancer mortality that have been observed in many countries over the last 20-25 years. I emphasize the trade-off between harms and benefits depending on the woman’s age and other risk factors. I also discuss ways for communicating the associated risks to women who have to decide whether screening (and what screening strategy) is right for them.

Lynge E, Ponti A, James T, Mojek O, von Euler-Chelpin M, Anttila A, et al. Variation in detection of ductal carcinoma in situ during screening mammography: A survey within the International Cancer Screening Network. Eur J Cancer. (0).
Available from: doi:
Conclusions Considerable international variation was found in DCIS detection. This variation could not be fully explained by variation in incidence nor in breast cancer detection rates. It suggests the potential for wide discrepancies in management of DCIS resulting in overtreatment of indolent DCIS or undertreatment of potentially curable disease. Comprehensive cancer registration is needed to monitor DCIS detection. Efforts to understand discrepancies and standardise management may improve care.


Nota bibliográfica cribado c mama 2013-07/08

Whelehan P, Evans A, Wells M, Macgillivray S. The effect of mammography pain on repeat participation in breast cancer screening: A systematic review. Breast 2013 Aug;22(4):389-394. DOI:10.1016/j.breast.2013.03.003; 10.1016/j.breast.2013.03.003. PMID:23541681.

The most robust evidence for an association between pain experienced at a previous mammogram and subsequent rates of re-attendance suggests that women who previously experienced pain are more likely than those who did not to fail to re-attend: RR 1.34 (95% CI: 0.94-1.91). The complexity of the pain phenomenon and of screening behaviours must be recognised. However, there is sufficient evidence to conclude that painful mammography contributes to non-re-attendance. Given the importance of cumulative participation, effective pain-reducing interventions in mammography are needed.

van Breest Smallenburg V, Nederend J, Voogd AC, Coebergh JW, van Beek M, Jansen FH, et al. Trends in breast biopsies for abnormalities detected at screening mammography: a population-based study in the Netherlands. Br J Cancer 2013 Jul 9;109(1):242-248. DOI:10.1038/bjc.2013.253; PMID:23695018.

Conclusion:The use of diagnostic surgical breast biopsies has decreased substantially. They have mostly been replaced by percutaneous CBs and this replacement did not result in an increase of diagnostic delays.

Gotzsche PC, Jorgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev 2013 Jun 4;6:CD001877. DOI:10.1002/14651858.CD001877.pub5; PMID:23737396.

AUTHORS' CONCLUSIONS: If we assume that screening reduces breast cancer mortality by 15% and that overdiagnosis and overtreatment is at 30%, it means that for every 2000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive finding.

van Luijt PA, Fracheboud J, Heijnsdijk EAM, den Heeten GJ, de Koning HJ. Nation-wide data on screening performance during the transition to digital mammography: Observations in 6 million screens. Eur J Cancer (0) DOI:

Conclusion In accordance to previous, smaller, studies, we can confirm that DM has a higher detection rate compared to SFM, at the cost of a higher recall rate and lower PPV. More DCIS and a higher fraction of very small tumours were detected with DM, which has positive consequences for the stage shift as a result of mass screening.

Kristiansen M, Lue-Kessing L, Mygind A, Razum O, Norredam M. Migration from low- to high-risk countries: a qualitative study of perceived risk of breast cancer and the influence on participation in mammography screening among migrant women in Denmark. European Journal of Cancer Care 2013:n/a-n/a. DOI:10.1111/ecc.12100.

Migrants are less likely to participate in mammography screening programmes compared with local-born populations in Europe. We explored perceptions of breast cancer risk and the influence on participation in mammography screening programmes among migrant women born in countries with low incidence rates of breast cancer. We conducted eight individual interviews and six group interviews including a total of 29 women aged 50?69 years living in Copenhagen, Denmark. Women were migrants born in Somalia, Turkey, Pakistan or Arab countries. Phenomenological analysis was used. Breast cancer was perceived to be caused by multiple factors, including genetics, health behaviour, stress, fertility and breastfeeding. Some women perceived breast cancer to be more prevalent in Denmark as compared with their country of birth, and perceived their risk of developing breast cancer to increase with length of stay in Denmark. Although most women agreed on the relevance of mammography screening, other cancers, chronic and infectious diseases and mental health problems were mentioned as equally or more important to target in public health programmes. A life course perspective comprising previous and current circumstances in country of birth as well as immigration country is important for understanding and influencing the screening behaviour of migrants.

Duffy SW, Parmar D. Overdiagnosis in breast cancer screening: the importance of length of observation period and lead time. Breast Cancer Res 2013 May 16;15(3):R41. DOI:10.1186/bcr3427. PMID:23680223. PMCID:PMC3706885.

CONCLUSION: Studies using shorter observation periods will overestimate overdiagnosis by inclusion of cancers diagnosed early due to lead time among the nominally overdiagnosed tumours.

 Feig SA. Pitfalls in accurate estimation of overdiagnosis: implications for screening policy and compliance. (editorial). Breast Cancer Res 2013 Aug 8;15(4):105. DOI:10.1186/bcr3448. PMID:23927453.

Stories in the public media that 30 to 50% of screen-detected breast cancers are overdiagnosed dissuade women from being screened because overdiagnosed cancers would never result in death if undetected yet do result in unnecessary treatment. However, such concerns are unwarranted because the frequency of overdiagnosis, when properly calculated, is only 0 to 5%. In the previous issue of Breast Cancer Research, Duffy and Parmar report that accurate estimation of the rate of overdiagnosis recognizes the effect of lead time on detection rates and the consequent requirement for an adequate number of years of follow-up. These indispensable elements were absent from highly publicized studies that overestimated the frequency of overdiagnosis.

Zahl PH, Jorgensen KJ, Gotzsche PC. Overestimated lead times in cancer screening has led to substantial underestimation of overdiagnosis. Br J Cancer 2013 Aug 20 DOI:10.1038/bjc.2013.427; PMID:23963144.

Conclusion:When overdiagnosis is not taken into account, lead time is substantially overestimated. Overdiagnosis adjusted for model-based lead time is a function tending to zero, with no simple interpretation. Furthermore, the estimates are not in general comparable, because they depend on both the duration of screening and duration of follow-up. In contrast, overdiagnosis adjusted for clinically relevant tumours is a point estimate (and interpreted as percentage), which we find is the most reasonable method.

Tilanus-Linthorst MM, Lingsma HF, Evans DG, Thompson D, Kaas R, Manders P, et al. Optimal age to start preventive measures in women with BRCA1/2 mutations or high familial breast cancer risk. Int J Cancer 2013 Jul;133(1):156-163. DOI:10.1002/ijc.28014; 10.1002/ijc.28014. PMID:23292943.

Women from high-risk families consider preventive measures for breast cancer including screening. Guidelines on screening differ considerably regarding starting age. We investigated whether age at diagnosis in affected relatives is predictive for age at diagnosis. We analyzed the age of breast cancer detection of 1,304 first- and second-degree relatives of 314 BRCA1, 164 BRCA2 and 244 high-risk participants of the Dutch MRI-SCreening study. The within- and between-family variance in the relative's age at diagnosis was analyzed with a random effect linear regression model. We compared the starting age of screening based on risk-group (25 years for BRCA1, 30 years for BRCA2 and 35 years for familial risk), on family history, and on the model, which combines both. The findings were validated in 63 families from the UK-MARIBS study. Mean age at diagnosis in the relatives varied between families; 95% range of mean family ages was 35-55 in BRCA1-, 41-57 in BRCA2- and 44-60 in high-risk families. In all, 14% of the variance in age at diagnosis, in BRCA1 even 23%, was explained by family history, 7% by risk group. Determining start of screening based on the model and on risk-group gave similar results in terms of cancers missed and years of screening. The approach based on familial history only, missed more cancers and required more screening years in both the Dutch and the United Kingdom data sets. Age at breast cancer diagnosis is partly dependent on family history which may assist planning starting age for preventive measures.


Nota bibliográfica cribado c mama 2013-06

Wübker A. Explaining variations in breast cancer screening across European countries. The European Journal of Health Economics 2013 06/07:1-18. DOI:10.1007/s10198-013-0490-3. Enlace:

Jagsi R, Hayman J. Informing Patient Decisions Regarding Management of Ductal Carcinoma In Situ. (editorial). Journal of the National Cancer Institute 2013 June 05;105(11):758-759. DOI:10.1093/jnci/djt113.

Soeteman DI, Stout NK, Ozanne EM, Greenberg C, Hassett MJ, Schrag D, et al. Modeling the Effectiveness of Initial Management Strategies for Ductal Carcinoma In Situ. Journal of the National Cancer Institute 2013 June 05;105(11):774-781. DOI:10.1093/jnci/djt096.

Conclusions Overall survival benefits of the six management strategies for DCIS are within 1 year, suggesting that treatment decisions can be informed by the patient’s preference for breast preservation and disutility for recurrence. Our delineation of personalized outcomes for each strategy can help patients understand the implications of their treatment choice, so their decisions may reflect their own personal values and help improve the quality of care for patients with DCIS.

Marmot MG. Sorting through the arguments on breast screening. JAMA 2013 May 30:1-2. DOI:10.1001/jama.2013.6822.
To those coming fresh to the argument, such disagreement seems surprising. Given the large body of evidence evaluating breast screening, it seems that the evidence would settle the issue. Such naiveté does not allow for the fact that people interpret evidence and, indeed, influence its generation. Judgments often reflect more about starting assumptions than they do about the nature of the evidence.

Puig-Vives M, Sanchez MJ, Sanchez-Cantalejo J, Torrella-Ramos A, Martos C, Ardanaz E, et al. Distribution and prognosis of molecular breast cancer subtypes defined by immunohistochemical biomarkers in a Spanish population-based study. Gynecol Oncol 2013 Jun 5 DOI:10.1016/j.ygyno.2013.05.039; PMID:23747837.
 CONCLUSION: The prognostic value of molecular subtype persists when adjusting for age, stage and histological grade. Hormone receptor positive tumors were associated with a better prognosis when compared with HER2-overexpressed and triple negative subtypes. Further research is required to improve triple negative prognosis.

Harris AL. Breast screening remains a controversial issue. (editorial). Br J Cancer 2013 Jun 11;108(11):2197. DOI:10.1038/bjc.2013.259; 10.1038/bjc.2013.259. PMID:23744282.

Hall P, Easton D. Breast cancer screening: time to target women at risk. (editorial). Br J Cancer 2013 Jun 11;108(11):2202-2204. DOI:10.1038/bjc.2013.257; 10.1038/bjc.2013.257. PMID:23744280.

Wu YY, Yen MF, Yu CP, Chen HH. Individually tailored screening of breast cancer with genes, tumour phenotypes, clinical attributes, and conventional risk factors. Br J Cancer 2013 May 14 DOI:10.1038/bjc.2013.202; 10.1038/bjc.2013.202. PMID:23674086.

Conclusion:We developed a novel quantitative approach following the principle of translational research to provide a roadmap with state-of-the-art genomic discovery and clinical parameters to facilitate individually tailored breast cancer screening.
Ceugnart L, Séradour B, Taieb S, Barreau B. Que penser des polémiques récentes sur le dépistage organisé des cancers du sein? Oncologie 2013 06/14:1-3. DOI:10.1007/s10269-013-2297-3. Enlace:

Otten JDM, Fracheboud J, den Heeten GJ, Otto SJ, Holland R, de Koning HJ, et al. Likelihood of early detection of breast cancer in relation to false-positive risk in life-time mammographic screening: population-based cohort study. Annals of Oncology 2013 June 19 DOI:10.1093/annonc/mdt227. PMID:23788759.

Conclusion Dutch women about to participate in the screening programme can be reassured that the chance of false-positive recall in the Netherlands is relatively low. A new screening policy and improved mammography have increased the detection of an early screening carcinoma and lowering the risk of interval carcinoma.


Nota bibliográfica cribado c mama 2013-05

Hofvind S, Ursin G, Tretli S, Sebuødegård S, Møller B. Breast cancer mortality in participants of the Norwegian Breast Cancer Screening Program. Cancer 2013:n/a-n/a.  DOI:10.1002/cncr.28174.
CONCLUSIONS After 15 years of follow-up, a 43% reduction in mortality was observed among women who attended the national mammographic screening program in Norway. Cancer 2013. © 2013 American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Cancer 2013. © 2013 American Cancer Society.

Miller AB. Overdiagnosis of breast cancer. (editorial). International Journal of Cancer 2013:n/a-n/a. DOI:10.1002/ijc.28258.

Falk RS, Hofvind S, Skaane P, Haldorsen T. Overdiagnosis among women attending a population-based mammography screening program. International Journal of Cancer 2013;133(3):705-712. DOI:10.1002/ijc.28052.
Increased incidence of ductal carcinoma in situ (DCIS) and invasive breast cancer (IBC) after introduction of organized screening has prompted debate about overdiagnosis. The aim was to examine the excess in incidence of DCIS and IBC during the screening period and the deficit after women left the program, and thereby to estimate the proportion of overdiagnosis. Women invited to the Norwegian Breast Cancer Screening Program were analyzed for DCIS or IBC during the period 1995?2009. Incidence rate ratios (IRRs) were calculated for attended vs. never attended women. The IRRs were adjusted by Mantel-Haenszel (MH) method and applied to a set of reference rates and a reference population to estimate the proportion of overdiagnosis during the women's lifespan after the age of 50 years. A total of 702,131 women were invited to the program. An excess of DCIS and IBC was observed among women who attended screening during the screening period; prevalently invited women aged 50?51 years had a MH IRR of 1.86 (95% CI 1.65?2.09) and subsequently invited women aged 52?69 years had a MH IRR of 1.56 (95% CI 1.45?1.68). In women aged 70?79 years, a deficit of 30% (MH IRR 0.70, 95% CI 0.62?0.80) was observed 1?10 years after they left the screening program. The estimated proportion of overdiagnosis varied from 10 to 20% depending on outcome and whether the women were invited or actually screened. The results highlight the need for individual data with longitudinal screening history and long-term follow-up as a basis for estimating overdiagnosis.

Zahl P, Suhrke P, Jørgensen KJ. Overdiagnosis of breast cancer in Norway: What have the authors adjusted for? (letter). International Journal of Cancer 2013:n/a-n/a. DOI:10.1002/ijc.28248.

Falk RS, Hofvind S, Skaane P, Haldorsen T. Response to comments by Kalager et al. and Zahl et al. (carta). International Journal of Cancer 2013:n/a-n/a. DOI:10.1002/ijc.28247.

Kalager M, Løberg M, Fønnebø VM, Bretthauer M. Failure to account for selection-bias. (carta). International Journal of Cancer 2013:n/a-n/a. DOI:10.1002/ijc.28244.

Baum M. The Marmot report: accepting the poisoned chalice. (editorial). Br J Cancer 2013 06/06Enlace:

Houssami N, Skaane P. Overview of the evidence on digital breast tomosynthesis in breast cancer detection. Breast 2013 Apr;22(2):101-108.
 DOI:10.1016/j.breast.2013.01.017; PMID:23422255.
Digital breast tomosynthesis (DBT, or 3D-mammography), a three-dimensional derivative of digital mammography (DM), reduces the effect of tissue superimposition and may improve mammographic interpretation. In this review, we examined the evidence on the accuracy of DBT in clinical studies. Published studies of DBT were relatively small studies, mostly test-set observer (reader) studies or clinical series that included symptomatic and screen-recalled cases, and were generally enriched with cancers. With these limitations in mind, the evidence showed some consistent findings, summarized as follows: two-view DBT has at least equal or better accuracy than standard two-view DM, whereas one-view DBT does not have better accuracy than standard DM; the addition of DBT to standard mammography (for mammographic interpretation or for assessment or triage of screen-recalled abnormalities) increases accuracy; improved accuracy from using DBT (relative to, or added to, DM) may be due to increased cancer detection or due to reduced false positive recalls, or both; and subjective interpretation of cancer conspicuity consistently found that cancers were equally or more conspicuous on DBT relative to DM. Preliminary data from population screening trials suggest that the integration of DBT with conventional DM (screen-reading using combined 2D + 3D mammography) may substantially improve breast cancer detection, although final results are not yet available, and many logistical issues need further evaluation to determine the potential implications and cost of combined 2D + 3D mammographic screening. At present, there is insufficient evidence to justify a change from standard DM to DBT however the available data strongly support investment in new large-scale population screening trials. These trials need to avoid the 'double' acquisitions required for 2D + 3D mammograms, and should therefore focus on evaluating integrated 2Dsynthetic + 3D mammography (where 2D-images are reconstructed from the DBT acquisition), and should consider using a randomized design.

Dourado F, Carreira H, Lunet N. Mammography use for breast cancer screening in Portugal: results from the 2005/2006 National Health Survey. The European Journal of Public Health 2013 June 01;23(3):386-392.


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