Assessment of nationwide cancer-screening programmes

doi:10.1016/S0140-6736(99)00419-5

The Lancet

Volume 355, Issue 9198, 8 January 2000, Pages 80-81

https://doi.org/10.1016/S0140-6736(99)00419-5 Get rights and content

References (18)

SA Narod
On being the right size: a reappraisal of mammography trials in Canada and Sweden
Lancet
(1997)
ER Horak et al.
Angiogenesis, assessed by platelet/endothelial cell adhesion molecule antibodies, as indicator of node metastases and survival in breast cancer
Lancet
(1992)
JCJM de Haes et al.
The impact of a breast cancer screening programme on quality-adjusted life-years
Int J Cancer
(1991)
I Fentiman
Detection and treatment of early breast cancer
(1990)
G Sjönell et al.
Mammographic screening does not reduce breast cancer mortality.[in Swedish]
Läkartidningen
(1999)
I Andersson et al.
Mammographic screening and mortality from breast cancer: the Malmö mammographic screening trial
BMT
(1988)
AB Miller et al.
Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 to 59 years
CMAJ
(1992)
F Alexander et al.
Randomisation by cluster and the problem of social class bias
J Epidemiol Community Health
(1989)
L Tabár et al.
Screening for breast cancer: the Swedish trial
Radiology
(1981)

There are more references available in the full text version of this article.

Cited by (78)

Screening Mammography Benefit Controversies. Sorting the Evidence
2014, Radiologic Clinics of North America
Citation Excerpt :
The writers suggested that the observed reduction in breast cancer death rates was caused by these age differences rather than by the screening process itself. Gotzsche and Olsen were unaware that when the screening trials used cluster randomization rather than individual randomization, such small age differences were not unexpected, in some cases biased the studies against screening, and were in any case fully accounted for in analyses, leaving the conclusion of a significant mortality reduction unchanged.85–87 Screening trials and therapeutic trials are different in nature and may be different in design.
Rational drug use - As common as common sense?
2012, Medical Journal Armed Forces India
Does participation to screening unintentionally influence lifestyle behaviour and thus lifestyle-related morbidity?
2010, Best Practice and Research: Clinical Gastroenterology
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One characteristic of screening programmes is that relatively few people will have large benefits from screening, whereas relatively many will be exposed to small, unfavourable effects. Important is that the favourable effects (reduction in disease specific mortality, life-years gained) of screening should reasonably outweigh the harms (overdiagnosis, overtreatment, false-positive screening result e.g.) caused by screening [7]. Relatively new is the question whether cancer screening might have an impact on future health related behaviour.
Cancer is a leading cause of death worldwide and the burden could be reduced by evidence-based strategies for the primary prevention of cancer, the early detection of malignancies and more adequate treatment of cancer patients.
Previous research has shown that lifestyle factors are associated with common cancers and that several cancer screening programmes are cost-effective in reducing cancer-specific mortality. But, some recent studies reported that participants of screening programs might unintentionally change their lifestyle. Cancer screening might be a teachable moment or, on the other hand, have a false health certificate effect. Despite that the evidence is scarce, cancer screening might have opportunities for lifestyle improvements, although a possible health certificate effect still remains. Integrated approaches to combine primary and secondary prevention have the potential to optimise the efforts to improve cancer prevention and survival. More research is warranted to investigate evidence-based approaches.
Screening Results, Controversies, and Guidelines
2010, Breast Imaging: Expert Radiology Series
Meta-analysis in medical research: Potentials and limitations
2008, Urologic Oncology: Seminars and Original Investigations
Citation Excerpt :
In addition, meta-analyses addressing the same issue have reached opposite conclusions. Examples include assessments of second-line antirheumatic drugs in the treatment of rheumatoid arthritis [57,58] and, more recently, mammography for breast cancer screening [59–61]. In the following sections, potential sources of bias are discussed in some detail.
Meta-analysis, the statistical combination of results from several studies to produce a single estimate of a treatment effect or size of an association, continues to attract controversy. We illustrate and discuss the promises and limitations of meta-analysis. Meta-analysis of clinical trials can prevent delays in the introduction of effective treatments or lead to the timely identification of adverse effects. However, meta-analyses are liable to numerous biases, both at the level of the individual study and the selection of studies for inclusion in meta-analysis. The biases and confounding factors that threaten the validity of individual studies will also affect meta-analyses of observational studies. We argue that meta-analyses should only be performed within the framework of systematic reviews that have been prepared using methods that minimize bias and address the combinability of studies.
A place for fiber diffraction in the detection of breast cancer?
2006, Cancer Detection and Prevention
Aims: To review the potential relevance and the place that a particular change in the fiber diffraction of hair might have in the future management of breast cancer and other pathologies. Method: A comprehensive overview was obtained using a complete search of the Australian National University Library (data range) and Medline (data range) using the search terms “review breast cancer screening/diagnosis/detection” and “X-ray diffraction of hair”. Publications in the past 5 years were selected but older reports that were commonly referenced were not excluded. Results: To date, our results have demonstrated that a specific change occurs in the diffraction pattern of hair for persons with breast cancer. Further research has shown that this change is present in the hair at an earlier stage of the cancer growth than is detectable by mammography. In addition, the change has been found to disappear when the cancer has been successfully removed. Discussion/conclusion: This technology uses only a few hairs, is totally user-friendly, non-invasive and does not require the patient to be exposed to any radiation. As a low-risk procedure, it could potentially provide a much needed, cost-effective early screening test for the presence of breast cancer in women of any age. As the patients are not required to be present during the test, it could also provide a testing service for women in remote areas. In this review, the origin of the diffraction pattern and the diagnostic information that can be gleaned from it are outlined.

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CommentaryAssessment of nationwide cancer-screening programmes

Lancet

Lancet

The impact of a breast cancer screening programme on quality-adjusted life-years

Int J Cancer

Detection and treatment of early breast cancer

Mammographic screening does not reduce breast cancer mortality.[in Swedish]

Läkartidningen

Mammographic screening and mortality from breast cancer: the Malmö mammographic screening trial

BMT

Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 to 59 years

CMAJ

Randomisation by cluster and the problem of social class bias

J Epidemiol Community Health

Screening for breast cancer: the Swedish trial

Radiology

Commentary
Assessment of nationwide cancer-screening programmes