Techniques and equipment in mammography - an aid to diagnosis

Breast Cancer Research, Oct 2000

J Berry-Smith, L Gustard

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Techniques and equipment in mammography - an aid to diagnosis

Abstracts from Symposium Mammographicum 2000 RG Blanks 3 4 7 8 9 10 12 14 15 16 17 0 Biostatistics Unit, Medical Research Council , Cambridge , UK 1 Information Technology Support Department, Uppsala University , Uppsala , Sweden 2 Department of Medical Radiology, University Hospital of Linköping , Linköping , Sweden 3 M Richards Department of Palliative Care, Guy's and St Thomas's Hospital NHS Trust , London , UK 4 Y Cooper Parliamentary Under-Secretary of State for Public Health, Department of Health , London , UK 5 Department of Mammography, Central Hospital , Falun , Sweden 6 Institute of Epidemiology, College of Public Health, National Taiwan University , Taipei , Taiwan 7 Cancer Screening Evaluation Unit, Institute of Cancer Research , Sutton , UK 8 RE Mansel Division of Surgery, University of Wales College of Medicine , Cardiff , UK 9 I Smith Department of Medical Oncology, Royal Marsden Hospital , London , UK 10 K Koufopoulos, I Garas, Ch Pateras, E Ampatzoglou , P Kakavoulis, A Michas, S Gravas, V Sarrou, D Tsitsimelis, M Tsompanlioti , N Papageorgiou, K Kapridaki and F De Waard Hellenic Society of Oncology , Athens , Greece 11 Department of Clinical Genetics 12 D O'Driscoll 13 Department of Radiology 14 H Gwynn Deputy to Acting Medical Director, NHS Executive Working Group on Workforce Issues in the Breast Screening Programme, Department of Health , Leeds , UK 15 A Gale Institute of Behavioural Sciences, University of Derby , Derby , UK 16 JA Fielding Department of Radiology, Royal Shrewsbury Hospital , Shrewsbury , UK 17 L Tabár Department of Mammography, Central Hospital , Falun , Sweden Future of breast cancer services Future of breast cancer services The Swedish Two-County Trial 20-years on: updated mortality results and new insights from longterm follow-up The Swedish Two-County Trial is a randomized controlled study of invitation to breast cancer screening. It was initiated in late 1977. The follow-up to the end of 1998 provides results at approximately the twentieth anniversary of the trial. A significant decrease in breast cancer death among women invited to screening was published 7-8 years after randomization and at 20-year follow up there is a significant 32% reduction in mortality associated with invitation to screening. The advent of screen-film mammographic screening with the ability to detect potentially fatal tumors at an early stage provides an opportunity to study the natural history of breast cancer at an earlier phase in its development than was possible in the past. Our findings show that breast cancer is not a systemic disease at its inception, but is a progressive disease and its development can be arrested by screening. Detection of < 15 mm and lymph node negative invasive tumors will save lives and confer an opportunity for less radical treatment. Mammography is clearly a very useful tool, not only for early detection of cancers but also for successful discrimination between the highly fatal and nonfatal cancers. The four mammographic prognostic features will be presented. Screening and its effect on breast cancer mortality rates In the Health of the Nation document published by the Department of Health in 1993 it was stated that the eventual success of the breast screening programme would be measured in terms of the breast cancer mortality reduction achieved. Unfortunately, outside the environment of randomised controlled trials the actual mortality reduction from screening is extremely difficult to measure with any precision. This is because national mortality statistics between the start of screening in 1988 and the present day have been affected not only by screening, but also by treatment improvements, cohort effects, earlier presentation outside the screening programme and even changes in the way breast cancer deaths are coded. Additionally, the full effect of screening in national statistics is not likely to be achieved until 2005–2010 rather than the year 2000, as often reported. This is because of two major factors. Firstly, many deaths from breast cancer in the 1990s will be from women who were diagnosed with breast cancer before invitation to screening (full coverage was not achieved until 1995). Secondly, the screening sensitivity of the NHSBSP did not achieve parity with the Swedish-Two County study until 1996/97. In the early years of screening there was a major shortfall of invasive cancers, which led to high interval cancer rates and a projected mortality reduction much less than 25%. The combination of these two factors will lead to a considerably lower mortality reduction than 25% by the year 2000. Nevertheless some mortality reduction from screening would be expected and standard epidemiological techniques (agecohort modelling) have been employed in an attempt to measure this. 6 7 Introducing MRI into clinical breast practice S Field Breast Screening Assessment Centre, Kent and Canterbury Hospital, Canterbury, UK Although there are numerous pub (...truncated)


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J Berry-Smith, L Gustard. Techniques and equipment in mammography - an aid to diagnosis, Breast Cancer Research, 2000, pp. A47, 2,