Skip to main content
PMC home page
British Journal of Cancer logoLink to British Journal of Cancer
. 1990 Feb;61(2):292–297. doi: 10.1038/bjc.1990.55

Breast cancer screening: its impact on clinical medicine.

H J de Koning 1, G J van Oortmarssen 1, B M van Ineveld 1, P J van der Maas 1
PMCID: PMC1971409  PMID: 2310681

Abstract

Breast cancer screening is generally accepted as an effective means of reducing breast cancer mortality in post-menopausal women. In this analysis the impact of nationwide screening on clinical medicine and the effects for the women involved are quantified. Effect estimates are based on results from screening trials in Utrecht (DOM-project) and Nijmegen, and on bi-annual screening of women aged 50-70. The consequences for health care are based on generally accepted assessment and treatment policies. The number of assessment procedures for non-palpable lesions will increase by 12% per year in the build-up period, and will remain slightly higher. The total number of biopsies in a real population is expected to decrease. Screening will lead to a shift in primary treatment modalities, as 15% of mastectomies will be replaced by breast conserving therapy. The temporary increase in the demand for primary treatment in the first years will be followed by a decrease in the demand for treating women with advanced disease. Favourable effects outweigh the inevitable unfavourable effects, with high quality screening and an appropriate invitation system. Breast cancer screening can also be recommended after considering other consequences than mortality reduction.

Full text

PDF
294

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersson I., Aspegren K., Janzon L., Landberg T., Lindholm K., Linell F., Ljungberg O., Ranstam J., Sigfússon B. Mammographic screening and mortality from breast cancer: the Malmö mammographic screening trial. BMJ. 1988 Oct 15;297(6654):943–948. doi: 10.1136/bmj.297.6654.943. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Collette H. J., Day N. E., Rombach J. J., de Waard F. Evaluation of screening for breast cancer in a non-randomised study (the DOM project) by means of a case-control study. Lancet. 1984 Jun 2;1(8388):1224–1226. doi: 10.1016/s0140-6736(84)91704-5. [DOI] [PubMed] [Google Scholar]
  3. Day N. E., Williams D. R., Khaw K. T. Breast cancer screening programmes: the development of a monitoring and evaluation system. Br J Cancer. 1989 Jun;59(6):954–958. doi: 10.1038/bjc.1989.203. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Gravelle H. S., Simpson P. R., Chamberlain J. Breast cancer screening and health service costs. J Health Econ. 1982 Aug;1(2):185–207. doi: 10.1016/0167-6296(82)90014-5. [DOI] [PubMed] [Google Scholar]
  5. Habbema J. D., van Oortmarssen G. J., van Putten D. J., Lubbe J. T., van der Maas P. J. Age-specific reduction in breast cancer mortality by screening: an analysis of the results of the Health Insurance Plan of Greater New York study. J Natl Cancer Inst. 1986 Aug;77(2):317–320. [PubMed] [Google Scholar]
  6. Harris J. R., Hellman S., Kinne D. W. Limited surgery and radiotherapy for early breast cancer. N Engl J Med. 1985 Nov 21;313(21):1365–1368. doi: 10.1056/nejm198511213132128. [DOI] [PubMed] [Google Scholar]
  7. Holland R., Veling S. H., Mravunac M., Hendriks J. H. Histologic multifocality of Tis, T1-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer. 1985 Sep 1;56(5):979–990. doi: 10.1002/1097-0142(19850901)56:5<979::aid-cncr2820560502>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  8. Holmberg L., Adami H. O., Persson I., Lundström T., Tabar L. Demands on surgical inpatient services after mass mammographic screening. Br Med J (Clin Res Ed) 1986 Sep 27;293(6550):779–782. doi: 10.1136/bmj.293.6550.779. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Knox E. G. Evaluation of a proposed breast cancer screening regimen. BMJ. 1988 Sep 10;297(6649):650–654. doi: 10.1136/bmj.297.6649.650. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Rosen P. P. The pathological classification of human mammary carcinoma: past, present and future. Ann Clin Lab Sci. 1979 Mar-Apr;9(2):144–156. [PubMed] [Google Scholar]
  11. Rosner D., Bedwani R. N., Vana J., Baker H. W., Murphy G. P. Noninvasive breast carcinoma: results of a national survey by the American College of Surgeons. Ann Surg. 1980 Aug;192(2):139–147. doi: 10.1097/00000658-198008000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Schnitt S. J., Silen W., Sadowsky N. L., Connolly J. L., Harris J. R. Ductal carcinoma in situ (intraductal carcinoma) of the breast. N Engl J Med. 1988 Apr 7;318(14):898–903. doi: 10.1056/NEJM198804073181406. [DOI] [PubMed] [Google Scholar]
  13. Shapiro S., Venet W., Strax P., Venet L., Roeser R. Ten- to fourteen-year effect of screening on breast cancer mortality. J Natl Cancer Inst. 1982 Aug;69(2):349–355. [PubMed] [Google Scholar]
  14. Skrabanek P. The debate over mass mammography in Britain. The case against. BMJ. 1988 Oct 15;297(6654):971–972. doi: 10.1136/bmj.297.6654.971. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Tabar L., Duffy S. W., Krusemo U. B. Detection method, tumour size and node metastases in breast cancers diagnosed during a trial of breast cancer screening. Eur J Cancer Clin Oncol. 1987 Jul;23(7):959–962. doi: 10.1016/0277-5379(87)90341-5. [DOI] [PubMed] [Google Scholar]
  16. Tabár L., Fagerberg C. J., Gad A., Baldetorp L., Holmberg L. H., Gröntoft O., Ljungquist U., Lundström B., Månson J. C., Eklund G. Reduction in mortality from breast cancer after mass screening with mammography. Randomised trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet. 1985 Apr 13;1(8433):829–832. doi: 10.1016/s0140-6736(85)92204-4. [DOI] [PubMed] [Google Scholar]
  17. Verbeek A. L., Hendriks J. H., Holland R., Mravunac M., Sturmans F., Day N. E. Reduction of breast cancer mortality through mass screening with modern mammography. First results of the Nijmegen project, 1975-1981. Lancet. 1984 Jun 2;1(8388):1222–1224. doi: 10.1016/s0140-6736(84)91703-3. [DOI] [PubMed] [Google Scholar]
  18. Warren R. The debate over mass mammography in Britain. The case for. BMJ. 1988 Oct 15;297(6654):969–970. doi: 10.1136/bmj.297.6654.969. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. van der Maas P. J., de Koning H. J., van Ineveld B. M., van Oortmarssen G. J., Habbema J. D., Lubbe K. T., Geerts A. T., Collette H. J., Verbeek A. L., Hendriks J. H. The cost-effectiveness of breast cancer screening. Int J Cancer. 1989 Jun 15;43(6):1055–1060. doi: 10.1002/ijc.2910430617. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES