Balancing harms and benefits of service mammography screening programs: a cohort study

INTRODUCTION: The use of screening mammography is still under debate within the medical community. The aim of this study is to define a balance sheet of benefits (breast cancer mortality reduction) and harms (overdiagnosis) for mammography screening programs. METHODS: We compared breast cancer incid...

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Autores principales: Puliti, Donella, Miccinesi, Guido, Zappa, Marco, Manneschi, Gianfranco, Crocetti, Emanuele, Paci, Eugenio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496124/
https://www.ncbi.nlm.nih.gov/pubmed/22230345
http://dx.doi.org/10.1186/bcr3090
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author Puliti, Donella
Miccinesi, Guido
Zappa, Marco
Manneschi, Gianfranco
Crocetti, Emanuele
Paci, Eugenio
author_facet Puliti, Donella
Miccinesi, Guido
Zappa, Marco
Manneschi, Gianfranco
Crocetti, Emanuele
Paci, Eugenio
author_sort Puliti, Donella
collection PubMed
description INTRODUCTION: The use of screening mammography is still under debate within the medical community. The aim of this study is to define a balance sheet of benefits (breast cancer mortality reduction) and harms (overdiagnosis) for mammography screening programs. METHODS: We compared breast cancer incidence and mortality in two cohorts of women, defined as 'attenders' or 'non-attenders' on the basis of the individual attitudes towards screening, who were invited to the first round of the Florentine screening program. The effects of screening exposure on breast cancer incidence and mortality were evaluated by fitting Poisson regression models adjusted for age at entry, marital status and deprivation index. We performed a sensitivity analysis excluding 34 women not responding to the invitation with a breast cancer diagnosis in the following six months. RESULTS: In total, we included 51,096 women aged 50 to 69 years invited at the first screening round (1991 to 1993) and followed-up for breast cancer incidence and mortality until 31 December 2007 and 31 December 2008, respectively The estimate of mortality reduction varies from 45% among 50 to 59 year-old women up to 51% among 60 to 69 year-old women. The estimate of overdiagnosis, according to the cumulative-incidence method, is an additional 10% of all breast cancer cases among 60 to 69 year-old women screened. CONCLUSIONS: Comparing the breast cancer mortality and breast cancer incidence between attenders and non-attenders, we have determined that the overall cost to save one life corresponds to no more than one over-diagnosed tumor (from 0.6 to 1 depending on the selection criteria of the cohort), even if a residual self-selection bias cannot be excluded.
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spelling pubmed-34961242012-11-14 Balancing harms and benefits of service mammography screening programs: a cohort study Puliti, Donella Miccinesi, Guido Zappa, Marco Manneschi, Gianfranco Crocetti, Emanuele Paci, Eugenio Breast Cancer Res Research Article INTRODUCTION: The use of screening mammography is still under debate within the medical community. The aim of this study is to define a balance sheet of benefits (breast cancer mortality reduction) and harms (overdiagnosis) for mammography screening programs. METHODS: We compared breast cancer incidence and mortality in two cohorts of women, defined as 'attenders' or 'non-attenders' on the basis of the individual attitudes towards screening, who were invited to the first round of the Florentine screening program. The effects of screening exposure on breast cancer incidence and mortality were evaluated by fitting Poisson regression models adjusted for age at entry, marital status and deprivation index. We performed a sensitivity analysis excluding 34 women not responding to the invitation with a breast cancer diagnosis in the following six months. RESULTS: In total, we included 51,096 women aged 50 to 69 years invited at the first screening round (1991 to 1993) and followed-up for breast cancer incidence and mortality until 31 December 2007 and 31 December 2008, respectively The estimate of mortality reduction varies from 45% among 50 to 59 year-old women up to 51% among 60 to 69 year-old women. The estimate of overdiagnosis, according to the cumulative-incidence method, is an additional 10% of all breast cancer cases among 60 to 69 year-old women screened. CONCLUSIONS: Comparing the breast cancer mortality and breast cancer incidence between attenders and non-attenders, we have determined that the overall cost to save one life corresponds to no more than one over-diagnosed tumor (from 0.6 to 1 depending on the selection criteria of the cohort), even if a residual self-selection bias cannot be excluded. BioMed Central 2012 2012-01-09 /pmc/articles/PMC3496124/ /pubmed/22230345 http://dx.doi.org/10.1186/bcr3090 Text en Copyright ©2012 Puliti et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Puliti, Donella
Miccinesi, Guido
Zappa, Marco
Manneschi, Gianfranco
Crocetti, Emanuele
Paci, Eugenio
Balancing harms and benefits of service mammography screening programs: a cohort study
title Balancing harms and benefits of service mammography screening programs: a cohort study
title_full Balancing harms and benefits of service mammography screening programs: a cohort study
title_fullStr Balancing harms and benefits of service mammography screening programs: a cohort study
title_full_unstemmed Balancing harms and benefits of service mammography screening programs: a cohort study
title_short Balancing harms and benefits of service mammography screening programs: a cohort study
title_sort balancing harms and benefits of service mammography screening programs: a cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496124/
https://www.ncbi.nlm.nih.gov/pubmed/22230345
http://dx.doi.org/10.1186/bcr3090
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