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Breast cancer screening might not affect mortality

Wednesday August 3, 2011
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Breast cancer screening has not played a direct role in the reductions of breast cancer mortality in recent years, according to a study.

Better treatment and improving health systems are more likely to have led to falling numbers of deaths from breast cancer than screening, said an international team of researchers, whose work appears on the website of the British Medical Journal.

The number of deaths from breast cancer is falling in many developed countries, the authors noted, but it is difficult to determine how much of that reduction over the past 20 years of mammography screening is due to earlier detection or to improved management.

The team compared trends in breast cancer mortality within three pairs of European countries – Northern Ireland versus Republic of Ireland, the Netherlands versus Belgium and Flanders, and Sweden versus Norway. The researchers expected that a reduction in breast cancer mortality would appear sooner in countries with earlier implementation of screening.

Countries of each pair had similar healthcare services and level of risk factors for breast cancer mortality, but were different in that mammography screening was implemented about 10 to 15 years later in the second country of each pair.

Data showed that from 1989 to 2006, deaths from breast cancer fell by 29% in Northern Ireland and 26% in the Republic of Ireland; by 25% in the Netherlands, 20% in Belgium and 25% in Flanders; and by 16% in Sweden and 24% in Norway.

These trends in breast cancer mortality rates did not vary greatly between countries where women had been screened by mammography for a considerable time compared with those where women were largely unscreened during that same period, the authors noted. Furthermore, the greatest reductions were in women ages 40 to 49, regardless of the availability of screening in this age group.

"The contrast between the time differences in implementation of mammography screening and the similarity in reductions in mortality between the country pairs suggest that screening did not play a direct part in the reductions in breast cancer mortality," the authors wrote. "Improvements in treatment and in the efficiency of healthcare systems may be more plausible explanations."

The study is available at http://www.bmj.com/content/343/bmj.d4411.full.

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