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

著者 Puliti D , Miccinesi G , Zappa M , Manneschi G , Crocetti E , Paci E
Breast Cancer Res.2012 Jan 9 ; 14(1):R9.
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ABSTRACT: 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 programmes. 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 programme. 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 invitation with a breast cancer diagnosis in the following 6 months. RESULTS: In total, we included 51.096 women aged 50-69 years invited at the first screening round (1991-1993) and followed-up for breast cancer incidence and mortality for a median time of 15.4 and 16.5 years respectively. The estimate of mortality reduction varies from 45% among 50-59 years old up to 51% among 60-69 years old. The estimate of overdiagnosis, according to the cumulative-incidence method, is an additional 10% of all breast cancer cases among 60-69 years old screened. CONCLUSIONS: Comparing the breast cancer mortality and breast cancer incidence between attenders and non-attenders, we have evaluated that the overall cost to save one life corresponds to no more than one overdiagnosed tumour (from 0.6 to 1 depending on the selection criteria of the cohort), even if a residual self-selection bias cannot be excluded.
PMID: 22230345 [PubMed - as supplied by publisher]
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