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.
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Introducing MRI into clinical breast practice
S Field
Breast Screening Assessment Centre, Kent and Canterbury Hospital, Canterbury, UK
Although there are numerous pub (...truncated)