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 2014-09

Natal C, Caicoya M, Prieto M, Tardón A. Incidencia de cáncer de mama en relación con la participación en un programa de cribado poblacional. Med Clin (Barc). 2014;(x). Available from: doi: 10.1016/j.medcli.2014.04.028.

Ascunce N. Sobrediagnóstico en programas de cribado de cáncer de mama: un efecto adverso inevitable que debe tenerse en cuenta. Med Clin (Barc). 2014;(x). Available from: doi: 10.1016/j.medcli.2014.07.017. PMID: 25178546.

Heinävaara S, Sarkeala T, Anttila A. Overdiagnosis due to breast cancer screening: updated estimates of the Helsinki service study in Finland. Br J Cancer. 2014;111(7):1463–8. Available from: doi: 10.1038/bjc.2014.413. PMID: 25121953.

Conclusions:Our estimates of overdiagnosis are of the same magnitude than other plausible estimates in Europe. Both alternative approaches produced similar estimates for the expected cumulative incidence, which increased the confidence in the estimates of overdiagnosis.

Overdiagnosis from mammographic screening. Position Statment. 2014.
Summary Cancer Australia supports the importance of mammographic screening in reducing breast cancer mortality. The national BreastScreen Australia Evaluation indicated a reduction in breast cancer mortality for the age group of 50-69 years of approximately 21-28% at the participation level of 56%. Participation in the BreastScreen Australia Program would result in around 8 deaths prevented for every 1000 women screened every two years from age 50 to age 74. A majority of breast cancers found through screening would be progressive and would become symptomatic within a woman’s lifetime if left untreated. It is likely that some screen-detected breast cancers (ductal carcinoma in situ or invasive breast cancer) might never have progressed to become symptomatic in a woman’s lifetime. Detection of these cancers is sometimes referred to as “overdiagnosis”. It is not possible to precisely predict at diagnosis, to which cancers overdiagnosis would apply. Estimates of overdiagnosis vary widely. Based on UK and European reviews, it is estimated that for every 1000 women in Australia who are screened every two years from age 50 to age 74, around 8 (between 2 and 21) breast cancers may be found and treated that would not have been found in a woman’s lifetime. Research is needed, including molecular and genomic research, to find means of identifying cancers that would be of minimal risk of progression and therefore could be managed more conservatively.

Bell RJ. Screening mammography - early detection or over-diagnosis? Contribution from Australian data. Climacteric. 2014;1–7. Available from: doi: 10.3109/13697137.2014.956718. PMID: 25224048.

Conclusions The benefits and harms of screening mammography are finely balanced. The impact of screening mammography is at best neutral but may result in overall harm. Women should be informed of the issue of over-diagnosis. It is time to review whether organized mammographic screening programs should continue.

Waller J, Whitaker KL, Winstanley K, Power E, Wardle J. A survey study of women’s responses to information about overdiagnosis in breast cancer screening in Britain. Br J Cancer. 2014;(August):1–5. Available from: doi: 10.1038/bjc.2014.482. PMID: 25167224.

Conclusions:Brief written information on overdiagnosis was incompletely understood, but reduced breast screening intentions in a proportion of women, regardless of comprehension. Subjective comprehension was lower among women who had not yet reached screening age but the deterrent effect was higher.British Journal of Cancer advance online publication, 28 August 2014; doi:10.1038/bjc.2014.482

Munoz D, Near AM, van Ravesteyn NT, Lee SJ, Schechter CB, Alagoz O, et al. Effects of Screening and Systemic Adjuvant Therapy on ER-Specific US Breast Cancer Mortality. J Natl Cancer Inst. 2014;106(11). Available from: doi: 10.1093/jnci/dju289.

Conclusion As advances in risk assessment facilitate identification of women with increased risk of ER-negative breast cancer, additional mortality reductions could be realized through more frequent targeted screening, provided these benefits are balanced against screening harms.

Coldman A, Phillips N, Wilson C, Decker K, Chiarelli AM, Brisson J, et al. Pan-Canadian Study of Mammography Screening and Mortality from Breast Cancer. J Natl Cancer Inst. 2014;106(11). Available from: doi: 10.1093/jnci/dju261.

Conclusion Participation in mammography screening programs in Canada was associated with substantially reduced breast cancer mortality


Nota bibliográfica cribado c mama 2014-07/08

Irvin VL, Kaplan RM. Screening mammography & breast cancer mortality: meta-analysis of quasi-experimental studies. PLoS One. 2014;9(6):e98105. Available from:  doi: 10.1371/journal.pone.0098105. PMID: 24887150.

CONCLUSIONS: Mammography screening may have modest effects on cancer mortality between the ages of 50 and 69 and non-significant effects for women older than age 70. Results are consistent with meta-analyses of RCTs. Effects on total mortality could not be assessed because of the limited number of studies.

Cedolini C, Bertozzi S, Londero AP, Bernardi S, Seriau L, Concina S, et al. Type of Breast Cancer Diagnosis, Screening, and Survival. Clin Breast Cancer. 2014;14(4):235–40. Available from: doi:

Conclusion The diagnosis of invasive breast cancer with screening in our population resulted in a survival gain at 5 years from the diagnosis, but a longer follow-up is necessary to confirm this data.

Fuhrman BJ, Byrne C. Comparing Mammographic Measures Across Populations (editorial]. J Natl Cancer Inst. 2014;106(5). Available from:  doi: 10.1093/jnci/dju109.

Pettersson A, Graff RE, Ursin G, dos Santos Silva I, McCormack V, Baglietto L, et al. Mammographic Density Phenotypes and Risk of Breast Cancer: A Meta-analysis. J Natl Cancer Inst. 2014;106(5). Available from:  doi: 10.1093/jnci/dju078.

Conclusions The results suggest that percentage dense area is a stronger breast cancer risk factor than absolute dense area. Absolute nondense area was inversely associated with breast cancer risk, but it is unclear whether the association is independent of absolute dense area.

Luqmani Y. Breast screening: an obsessive compulsive disorder. Cancer Causes Control. 2014;1–4. Available from: doi: 10.1007/s10552-014-0430-2.

Brand JS, Czene K, Shepherd JA, Leifland K, Heddson B, Sundbom A, et al. Automated measurement of volumetric mammographic density: a tool for widespread breast cancer risk assessment. Cancer Epidemiol Biomarkers Prev. 2014; Available from: doi: 10.1158/1055-9965.EPI-13-1219.

Conclusions: In a high-throughput setting Volpara performs well and in accordance with the behavior of established density measures. Impact: Automated measurement of volumetric mammographic density is a promising tool for widespread breast cancer risk assessment.

Berg WA. How Well Does Supplemental Screening Magnetic Resonance Imaging Work in High-Risk Women ? J Clin Oncol. 2014;1–5. doi: 10.1200/JCO.2014.56.2975.

Chiarelli AM, Prummel M V, Muradali D, Majpruz V, Horgan M, Carroll JC, et al. Effectiveness of Screening With Annual Magnetic Resonance Imaging and Mammography: Results of the Initial Screen From the Ontario High Risk Breast Screening Program. J Clin Oncol. 2014; Available from: doi: 10.1200/JCO.2013.52.8331.

Conclusion Screening with annual MRI combined with mammography has the potential to be effectively implemented into an organized breast screening program for women at high risk for breast cancer. This could be considered an important management option for known BRCA gene mutation carriers.

Molinié F, Vanier A, Woronoff AS, Guizard A V, Delafosse P, Velten M, et al. Trends in breast cancer incidence and mortality in France 1990–2008. Breast Cancer Res Treat. 2014;147(1):167–75. Available from: doi: 10.1007/s10549-014-3073-9.

 The objective of this work was to detail the incidence and mortality trends of invasive and in situ breast cancer (BC) in France, especially regarding the development of screening, over the 1990–2008 period. Data issued from nine population-based cancer registries were studied. The incidence of invasive BC increased annually by 0.8 % from 1990 to 1996 and more markedly by 3.2 % from 1996 to 2003, and then sharply decreased until 2006 (−2.3 % per year), especially among women aged 50–69 years (−4.9 % per year). This trend was similar whatever the introduction date of the organized screening (OS) program in the different areas. The incidence of ductal carcinoma in situ steadily increased between 1990 and 2005, particularly among women aged 50–69 years and 70 and older. At the same time, the mortality from BC decreased annually by 1.1 % over the entire study period. This decrease was more pronounced in women aged 40–49 and 50–69 and, during the 1990–1999 period, in the areas where OS began in 1989–1991. The similarity in the incidence trends for all periods of implementation of OS in the different areas was striking. This suggests that OS alone does not explain the changes observed in incidence rate. Our study highlights the importance of closely monitoring the changes in incidence and mortality indicators, and of better understanding the factors causing variation.

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;50(10):1799–807. Available from: doi: 10.1016/j.ejca.2014.03.017. PMID: 24746887.

CONCLUSION: The evidence we report warrants rethinking of breast screening strategies and should be used to inform future evaluations of 2D/3D-mammography that assess whether or not the estimated incremental detection translates into improved screening outcomes such as a reduction in interval cancer rates.

Renart-Vicens G, Puig-Vives M, Albanell J, Castaner F, Ferrer J, Carreras M, et al. Evaluation of the interval cancer rate and its determinants on the Girona health region’s early breast cancer detection program. BMC Cancer. 2014;14(1):558. Available from:

CONCLUSIONS:The IC rate for the PEDBC is within the expected parameters, with a high proportion of cases of true interval cancers (54.5%) and a low proportion of false negatives (13.6%). The results show that the proportional incidence of IC is within the limits set by European Guidelines. Furthermore, it has been confirmed that IC display more aggressive clinicopathological characteristics than screening breast cancers.

Miller AB. Digital Mammography [editorial].  J Natl Cancer Inst. 2014;106(6). Available from:  doi: 10.1093/jnci/dju125.

Kerlikowske K, Hubbard R, Tosteson ANA. Higher Mammography Screening Costs Without Appreciable Clinical Benefit: The Case of Digital Mammography. J Natl Cancer Inst. 2014;106(8). Available from:  doi: 10.1093/jnci/dju191.

Missinne S, Bracke P. Age differences in mammography screening reconsidered: life course trajectories in 13 European countries. Eur J Public Health. 2014; Available from: doi: 10.1093/eurpub/cku077.

Conclusion: Age differences in mammography screening generally reflect the period effects of national screening policies. This leaves little room for economic theories about human health capital that leave out the institutional context of preventive health care provision.

Lerda D, Deandrea S, Freeman C, López-alcalde J, Neamtiu L, Nicholl C, et al. Report of a European survey breast cancer care services [Internet]. Luxembourg; 2014 p. VI–142. Available from:  doi: 10.2788/51070.

AL Mousa DS, Brennan PC, Ryan EA, Lee WB, Tan J, Mello-Thoms C. How Mammographic Breast Density Affects Radiologists’ Visual Search Patterns. Acad Radiol. (0). Available from: doi:

Conclusions. Increased mammographic breast density changes radiologists' visual search patterns. Dense areas of the parenchyma attracted greater visual attention in both high- and low-mammographic density cases, resulting in faster detection of lesions overlying the fibroglandular dense tissue, along with longer dwell times and greater number of fixations, as compared to lesions located outside the dense fibroglandular regions.

Sarkeala T, Luostarinen T, Dyba T, Anttila A. Breast carcinoma detection modes and death in a female population in relation to population-based mammography screening. Springerplus. 2014;3(1):348. Available from: doi: 10.1186/2193-1801-3-348.

Conclusions The study demonstrates a novel approach to examine associations between breast carcinoma incidence and mortality within and outside population-based screening. The results show mammography screening having a distinct role in overall breast carcinoma incidence and mortality.

Nederend J, Duijm LEM, Louwman MWJ, Roumen RMH, Jansen FH, Voogd AC. Trends in surgery for screen-detected and interval breast cancers in a national screening programme. Br J Surg. 2014;101(8):949–58. Available from:  doi: 10.1002/bjs.9530. PMID: 24828281.

CONCLUSION: Mastectomy rates doubled during a 14-year period of screening mammography and the proportion of positive resection margins decreased, with variation among hospitals. The latter observation stresses the importance of quality control programmes for hospitals treating women with breast cancer.

Hofvind S, Skaane P, Elmore JG, Sebuødegård S, Hoff SR, Lee CI. Mammographic performance in a population-based screening program: before, during, and after the transition from screen-film to full-field digital mammography. Radiology. 2014;272(1):52–62. Available from:  doi: 10.1148/radiol.14131502. PMID: 24689858.

CONCLUSION: After the initial transitional phase from SFM to FFDM, population-based screening with FFDM is associated with less harm because of lower recall and biopsy rates and higher positive predictive values after biopsy than screening with SFM.


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.


Nota bibliográfica cribado c mama 2014-05

Gunsoy NB, Garcia-Closas M, Moss SM. Estimating breast cancer mortality reduction and overdiagnosis due to screening for different strategies in the United Kingdom. Br J Cancer. 2014;110(10):2412–9. Available from:

Conclusions: Estimates of mortality reduction and overdiagnosis were highly dependent on screening frequency, age range, and uptake, which may explain differences between some previous estimates obtained from randomised trials and from service screening.

Dent T, Jbilou J, Rafi I, Segnan N, Törnberg S, Chowdhury S, et al. Stratified Cancer Screening: The Practicalities of Implementation. Public Health Genomics. Basel; 2013;16(3):94–9. Available from: doi:

Conclusion: Stratified screening based on genetic testing is a radically new approach to prevention. Various organisational issues would need to be considered before it could be introduced, and a number of questions require further research.

Stout NK, Lee SJ, Schechter CB, Kerlikowske K, Alagoz O, Berry D, et al. Benefits, Harms, and Costs for Breast Cancer Screening After US Implementation of Digital Mammography. J Natl Cancer Inst. 2014;106(6):dju092.
Available from:

Conclusions The transition to digital breast cancer screening in the United States increased total costs for small added health benefits. The value of digital mammography screening among women aged 40 to 49 years depends on women’s preferences regarding false positives.

Smith RA. Counterpoint: Overdiagnosis in Breast Cancer Screening. J Am Coll Radiol. 2014;(0). Available from:
Berlin L. Point: Mammography, Breast Cancer, and Overdiagnosis: The Truth Versus the Whole Truth Versus Nothing but the Truth. J Am Coll Radiol. 2014;(0). Available from:

American College of Obstetricians and Gynecologists. Management of women with dense breasts diagnosed by mammography. Committee Opinion No. 593. American College of Obstetricians and Gynecologists. Obs Gynecol. 2014;123(593):910–1.

Helvie MA, Chang JT, Hendrick RE, Banerjee M. Reduction in late-stage breast cancer incidence in the mammography era: Implications for overdiagnosis of invasive cancer. Cancer. 2014;n/a–n/a. Available from: PMID: 24840597.

BACKGROUND Mammographic screening is expected to decrease the incidence of late-stage breast cancer. In the current study, the authors determined the decrease in late-stage cancer incidence and the changes in invasive cancer incidence that occurred in the mammographic era after adjusting for prescreening temporal trends. METHODS Breast cancer incidence and stage data were obtained from the Surveillance, Epidemiology, and End Results program. The premammography period (1977-1979) was compared with the mammographic screening period (2007-2009) for women aged ≥ 40 years. The authors estimated prescreening temporal trends using 5 measures of annual percentage change (APC). Stage-specific incidence values from 1977 through 1979 (baseline) were adjusted using APC values of 0.5%, 1.0%, 1.3%, and 2.0% and then compared with observed stage-specific incidence in 2007 through 2009. RESULTS Prescreening APC temporal trend estimates ranged from 0.8% to 2.3%. The joinpoint estimate of 1.3% for women aged ≥ 40 years approximated the 4-decade long APC trend of 1.2% noted in the Connecticut Tumor Registry. At an APC of 1.3%, late-stage breast cancer incidence decreased by 37% (56 cases per 100,000 women) with a reciprocal increase in early-stage rates noted from 1977 through 1979 to 2007 through 2009. Resulting late-stage cancer incidence decreased from 21% at an APC of 0.5% to 48% at an APC of 2.0%. Total invasive breast cancer incidence decreased by 9% (27 cases per 100,000 women) at an APC of 1.3%. CONCLUSIONS There is evidence that a substantial reduction in late-stage breast cancer has occurred in the mammography era when appropriate adjustments are made for prescreening temporal trends. At background APC estimates of ≥ 1%, the total invasive breast cancer incidence also decreased. Cancer 2014. © 2014 American Cancer Society.

Feig SA. Screening Mammography Benefit Controversies: Sorting the Evidence. Radiol Clin North Am. 2014;52(3):455–80. Available from: doi:
 KEY POINTS  Numerous clinical studies have confirmed that screening women age 40 years and older reduces breast cancer mortality by 30% to 50%. Several factors including faster breast cancer growth rates and lower breast cancer incidence among younger women, as well as shorter life expectancy and more comorbid conditions among older women, should also be considered in screening guidelines. Annual screening beginning at age 40 years and continuing with no upper age limit, as long as a woman has a life expectancy of at least 5 years and no significant comorbid conditions, is currently recommended by the American Cancer Society, the American College of Radiology, and the Society of Breast Imaging.
Bernardi D, Caumo F, Macaskill P, Ciatto S, Pellegrini M, Brunelli S, et al. Effect of integrating 3D-mammography (digital breast tomosynthesis) with 2D-mammography on radiologists’ true-positive and false-positive detection in a population breast screening trial. Eur J Cancer. 2014;50(7):1232–8. Available from: doi: 10.1016/j.ejca.2014.02.004. PMID: 24582915.

CONCLUSION: There was broad variability in radiologist-specific TP detection at 2D-mammography and hence in the additional TP detection and incremental CDR attributable to integrated 2D/3D-mammography; more consistent (less variable) TP-detection estimates were observed for the integrated screen-read. Integrating 3D-mammography with 2D-mammography improves radiologists’ screen-reading through improved cancer detection and/or reduced FPR, with most readers achieving both using integrated 2D/3D mammography.

Conant EF. Clinical Implementation of Digital Breast Tomosynthesis. Radiol Clin North Am. 2014;52(3):499–518. Available from: doi: 10.1016/j.rcl.2013.11.013. PMID: 24792652.

Digital breast tomosynthesis is rapidly being implemented in breast imaging clinics across the world as early clinical data demonstrate that this innovative technology may address some of the long-standing limitations of conventional mammography. This article reviews the recent clinical data supporting digital breast tomosynthesis implementation, the basics of digital breast tomosynthesis image interpretation using case-based illustrations, and potential issues to consider as this new technology is integrated into daily clinical use


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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