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Fohlin, Helena
Publications (10 of 11) Show all publications
Fohlin, H. (2018). Long-term prognostic and predictive factors in hormone receptor positive breast cancer. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Long-term prognostic and predictive factors in hormone receptor positive breast cancer
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The breast cancer survival in Sweden is good (almost 90 % 5-year relative survival) and has increased over time. For women with hormone receptor negative tumors, most relapses occur within the first 5 years after diagnosis. Thereafter the recurrence risk decreases rapidly. For women with estrogen receptor positive (ER+) tumors the annual risk for late recurrences is 1 – 2 %, even after 5 years of endocrine therapy. This risk accumulates so that approximately 25 % of the patients that are recurrence-free after five years from diagnosis may experience a relapse within further 15 years of follow-up. The relatively high long-term risk calls for identification of prognostic and predictive markers with long-term effect. Though, the number of such markers with proven significance is limited. Of the clinical characteristics, only nodal status and to some extent tumor size and tumor grade have been shown to have long-term prognostic value. In this thesis, we propose long-term prognostic and predictive markers for breast cancer.

In paper I, we suggest the protein v-akt murine thymoma viral oncogene homologue 2 (AKT2) as a long-term prognostic marker among patients with ER+ tumors. In our study, besides nodal status, AKT2 was the only factor with long-term prognostic value. This is in accordance with some other studies, though we also showed that the significance of AKT2 was limited to ER+ tumors and that the impact increased with higher ER expression.

Approximately 75 – 85 % of the ER+ tumors are also progesterone receptor positive (PR+). ER+/progesterone receptor negative (PR-) tumors are considered to be more aggressive and patients with such tumors are often treated with chemotherapy. In this group, more specific subgroups for targeted therapy are needed.

Whereas ER has long been established as a predictive factor regarding tamoxifen benefit, the role of PR has not been clarified to date. In paper II, we showed that PR status adds predictive value to ER considering the long-term benefit from tamoxifen.

In paper III, we aimed to identify new prognostic markers among patients with ER+ tumors. Systemically untreated patients with ER+/PR- tumors and high expression of the Ras-related protein RAB6C (RAB6C) had reduced distant recurrence rate. Therefore, we suggest RAB6C as a candidate marker for subgroup division among patients with ER+/PR- tumors.

According to the results from paper II, there might be subgroups of patients with ER+/PRtumors that do benefit from tamoxifen. The aim of paper IV was to identify such subgroups. Here, we suggest that patients with ER+/PR- tumors and low RAB6C expression do benefit from tamoxifen.

The results from this thesis may encourage further studies for more specific subgroup divisions. Such studies may lead to changes in the management program, where some patients with ER+ tumors should receive prolonged or more intense treatment and others reduced treatment based on the pathological markers AKT2, PR and RAB6C. 

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 64
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1607
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-145398 (URN)10.3384/diss.diva-145398 (DOI)9789176853726 (ISBN)
Public defence
2018-03-29, Hasselquistsalen, Hus 511, Campus US, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2018-02-28 Created: 2018-02-28 Last updated: 2018-02-28Bibliographically approved
El Ouali, M., Fohlin, H. & Srivastav, A. (2016). An approximation algorithm for the partial vertex cover problem in hypergraphs. Journal of combinatorial optimization, 31(2), 846-864
Open this publication in new window or tab >>An approximation algorithm for the partial vertex cover problem in hypergraphs
2016 (English)In: Journal of combinatorial optimization, ISSN 1382-6905, E-ISSN 1573-2886, Vol. 31, no 2, p. 846-864Article in journal (Refereed) Published
Abstract [en]

Let be a hypergraph with set of vertices and set of (hyper-)edges . Let be the maximum size of an edge, be the maximum vertex degree and be the maximum edge degree. The -partial vertex cover problem in hypergraphs is the problem of finding a minimum cardinality subset of vertices in which at least hyperedges are incident. For the case of and constant it known that an approximation ratio better than cannot be achieved in polynomial time under the unique games conjecture (UGC) (Khot and Ragev J Comput Syst Sci, 74(3):335-349, 2008), but an -approximation ratio can be proved for arbitrary (Gandhi et al. J Algorithms, 53(1):55-84, 2004). The open problem in this context has been to give an -ratio approximation with , as small as possible, for interesting classes of hypergraphs. In this paper we present a randomized polynomial-time approximation algorithm which not only achieves this goal, but whose analysis exhibits approximation phenomena for hypergraphs with not visible in graphs: if and are constant, and , we prove for -uniform hypergraphs a ratio of , which tends to the optimal ratio 1 as tends to . For the larger class of hypergraphs where , is not constant, but is a constant, we show a ratio of . Finally for hypergraphs with non-constant , but constant , we get a ratio of for , leaving open the problem of finding such an approximation for k < m/4(.)

Place, publisher, year, edition, pages
SPRINGER, 2016
Keywords
Combinatorial optimization; Approximation algorithms; Hypergraphs; Vertex cover; Probabilistic methods
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-125307 (URN)10.1007/s10878-014-9793-2 (DOI)000368686900024 ()
Available from: 2016-02-24 Created: 2016-02-19 Last updated: 2017-11-30
Nordenskjold, A. E., Fohlin, H., Albertsson, P., Arnesson, L.-G., Chamalidou, C., Einbeigi, Z., . . . Karlsson, P. (2015). No clear effect of postoperative radiotherapy on survival of breast cancer patients with one to three positive nodes: a population-based study. Annals of Oncology, 26(6), 1149-1154
Open this publication in new window or tab >>No clear effect of postoperative radiotherapy on survival of breast cancer patients with one to three positive nodes: a population-based study
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2015 (English)In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 26, no 6, p. 1149-1154Article in journal (Refereed) Published
Abstract [en]

Background: In published radiotherapy trials, the failure rate in the control arm among patients with one to three positive nodes is high compared with that seen with modern adjuvant treatments. Therefore, the generalizability of the results has been questioned. The aim of the present study was to compare relative survival in breast cancer patients between two Swedish regions with screening mammography programs and adjuvant treatment guidelines similar with the exception of the indication of radiotherapy for patients with one to three positive nodes. Patients and methods: Between 1989 and 2006, breast cancer patients were managed very similarly in the west and southeast regions, except for indication for postoperative radiotherapy. In patients with one to three positive nodes, post-mastectomy radiotherapy was generally given in the southeast region (89% of all cases) and generally not given in the west region (15% of all cases). For patients with one to three positive nodes who underwent breast-conserving surgery, patients in the west region had breast radiotherapy only, while patients in the southeast region had both breast and lymph nodes irradiated. Results: The 10-year relative survival for patients with one to three positive lymph nodes was 78% in the west region and 77% in the southeast region (P = 0.12). Separate analyses depending on type of surgery, as well as number of examined nodes, also revealed similar relative survival. Conclusion: Locoregional postoperative radiotherapy has well-known side-effects, but in this population-based study, there was little or no influence of this type of radiotherapy on survival when one to three lymph nodes were involved.

Place, publisher, year, edition, pages
Oxford University Press (OUP): Policy B - Oxford Open Option F, 2015
Keywords
postoperative radiotherapy; breast cancer; positive nodes
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-120464 (URN)10.1093/annonc/mdv159 (DOI)000357997500016 ()25839671 (PubMedID)
Available from: 2015-08-12 Created: 2015-08-11 Last updated: 2017-12-04
Johansson, H. J., Sanchez, B. C., Forshed, J., Stål, O., Fohlin, H., Lewensohn, R., . . . Linderholm, B. K. (2015). Proteomics profiling identify CAPS as a potential predictive marker of tamoxifen resistance in estrogen receptor positive breast cancer. Clinical Proteomics, 12(1), 8
Open this publication in new window or tab >>Proteomics profiling identify CAPS as a potential predictive marker of tamoxifen resistance in estrogen receptor positive breast cancer
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2015 (English)In: Clinical Proteomics, ISSN 1542-6416, E-ISSN 1559-0275, Vol. 12, no 1, p. 8-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Despite the success of tamoxifen since its introduction, about one-third of patients with estrogen (ER) and/or progesterone receptor (PgR) - positive breast cancer (BC) do not benefit from therapy. Here, we aim to identify molecular mechanisms and protein biomarkers involved in tamoxifen resistance.

RESULTS: Using iTRAQ and Immobilized pH gradient-isoelectric focusing (IPG-IEF) mass spectrometry based proteomics we compared tumors from 12 patients with early relapses (<2 years) and 12 responsive to therapy (relapse-free > 7 years). A panel of 13 proteins (TCEAL4, AZGP1, S100A10, ALDH6A1, AHNAK, FBP1, S100A4, HSP90AB1, PDXK, GFPT1, RAB21, MX1, CAPS) from the 3101 identified proteins, potentially separate relapse from non-relapse BC patients. The proteins in the panel are involved in processes such as calcium (Ca(2+)) signaling, metabolism, epithelial mesenchymal transition (EMT), metastasis and invasion. Validation of the highest expressed proteins in the relapse group identify high tumor levels of CAPS as predictive of tamoxifen response in a patient cohort receiving tamoxifen as only adjuvant therapy.

CONCLUSIONS: This data implicate CAPS in tamoxifen resistance and as a potential predictive marker.

Keywords
CAPS; Calcyphosine; Endocrine resistance; Estrogen receptor; MX1; Proteomics; Receptor-positive breast cancer
National Category
Cancer and Oncology Cell and Molecular Biology
Identifiers
urn:nbn:se:liu:diva-125931 (URN)10.1186/s12014-015-9080-y (DOI)25878567 (PubMedID)
Available from: 2016-03-09 Created: 2016-03-09 Last updated: 2018-01-10
El Ouali, M., Fohlin, H. & Srivastav, A. (2014). A randomised approximation algorithm for the hitting set problem. Theoretical Computer Science, 555, 23-34
Open this publication in new window or tab >>A randomised approximation algorithm for the hitting set problem
2014 (English)In: Theoretical Computer Science, ISSN 0304-3975, E-ISSN 1879-2294, Vol. 555, p. 23-34Article in journal (Refereed) Published
Abstract [en]

Let H = (V, epsilon) be a hypergraph with vertex set V and edge set epsilon, where n := vertical bar V vertical bar and m := vertical bar epsilon vertical bar. Let l be the maximum size of an edge and Delta be the maximum vertex degree. A hitting set (or vertex cover) in H is a subset of V in which all edges are incident. The hitting set problem is to find a hitting set of minimum cardinality. It is known that an approximation ratio of l can be achieved easily. On the other hand, for constant l, an approximation ratio better than l cannot be achieved in polynomial time under the unique games conjecture (Khot and Regev, 2008 [17]). Thus breaking the l-barrier for significant classes of hypergraphs is a complexity-theoretically and algorithmically interesting problem, which has been studied by several authors (Krivelevich, 1997 [18], Halperin, 2000 [12], Okun, 2005 [23]). We propose a randomised algorithm of hybrid type for the hitting set problem, which combines LP-based randomised rounding, graphs sparsening and greedy repairing and analyse it for different classes of hypergraphs. For hypergraphs with Delta = O(n1/4) and l = O (root n) we achieve an approximation ratio of l(1 - c/Delta), for some constant c greater than 0, with constant probability. For the case of hypergraphs where l and Delta are constants, we prove a ratio of l(1 - l-1/8 Delta). The latter is done by analysing the expected size of the hitting set and using concentration inequalities. Moreover, for quasi-regularisable hypergraphs, we achieve an approximation ratio of l(1 - n/8m). We show how and when our results improve over the results of Krivelevich, Halperin and Okun.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Approximation algorithms; Probabilistic methods; Randomised rounding; Hitting set; Vertex cover; Greedy algorithms
National Category
Computer and Information Sciences Mathematics
Identifiers
urn:nbn:se:liu:diva-112302 (URN)10.1016/j.tcs.2014.03.029 (DOI)000343627600004 ()
Available from: 2014-11-24 Created: 2014-11-24 Last updated: 2018-01-11
Fohlin, H., Perez-Tenorio, G., Fornander, T., Skoog, L., Nordenskjöld, B., Carstensen, J. & Stål, O. (2013). Akt2 expression is associated with good long-term prognosis in oestrogen receptor positive breast cancer. European Journal of Cancer, 49(6), 1196-1204
Open this publication in new window or tab >>Akt2 expression is associated with good long-term prognosis in oestrogen receptor positive breast cancer
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2013 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, no 6, p. 1196-1204Article in journal (Refereed) Published
Abstract [en]

Introduction

Akt is a signalling modulator for many cellular processes, including metabolism, cell proliferation, cell survival and cell growth. Three isoforms of Akt have been identified, but only a few studies have concerned the isoform-specific roles in the prognosis of breast cancer patients. The aim of this study was to investigate the prognostic value of v-akt murine thymoma viral oncogene homologue 1 (Akt1) and v-akt murine thymoma viral oncogene homologue 2 (Akt2) in oestrogen receptor positive (ER+) and oestrogen receptor negative (ER–) breast cancer with long-term follow-up.

Material and methods

The expression of Akt in tumour tissue was analysed with immunohistochemistry in a cohort of 272 postmenopausal patients with stage II breast cancer. The median follow-up time was 19 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox’s proportional hazards model.

Results

The risk of distant recurrence was reduced for patients with ER+ tumours expressing Akt2 compared to patients with no Akt2 expression (HR = 0.49, 95% CI 0.29–0.82, p = 0.007). When adjusting for important clinical tumour characteristics and treatment, Akt2 was still an independent prognostic factor (HR = 0.38, 95% CI 0.21–0.68, p = 0.001) and the association remained long-term. The prognostic value of Akt2 increased with higher oestrogen receptor levels from no effect among patients with ER– tumours to 68% risk reduction for the group with high ER-levels (P for trend = 0.042). Akt1 showed no significant prognostic information.

Conclusion

Our results indicate that Akt2 expression is associated with a lower distant recurrence rate for patients with ER+ tumours and that this association remains long-term. The prognostic value of Akt2 increases with higher oestrogen receptor expression, motivating further mechanistic studies on the role of Akt2 in ER+ breast cancer.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Breast cancer, Akt, Protein kinase B, Oestrogen receptor, Long-term, Prognostic factor
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-92610 (URN)10.1016/j.ejca.2012.12.006 (DOI)000317188600005 ()
Note

Funding Agencies|Swedish Cancer Society||Swedish Research Council||

Available from: 2013-05-16 Created: 2013-05-14 Last updated: 2018-02-28
Sörenson, S., Fohlin, H., Lindgren, A., Lindskog, M., Bergman, B., Sederholm, C., . . . Clinchy, B. (2013). Predictive role of plasma vascular endothelial growth factor for the effect of celecoxib in advanced non-small cell lung cancer treated with chemotherapy. European Journal of Cancer, 49(1), 115-120
Open this publication in new window or tab >>Predictive role of plasma vascular endothelial growth factor for the effect of celecoxib in advanced non-small cell lung cancer treated with chemotherapy
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2013 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, no 1, p. 115-120Article in journal (Refereed) Published
Abstract [en]

Aim of the study: The primary purpose of this study is to investigate if pretreatment plasma levels of vascular endothelial growth factor (VEGF) are predictive of the effect of celecoxib on survival in advanced non-small cell lung cancer (NSCLC) treated with palliative chemotherapy. A secondary objective is to describe the course of plasma VEGF levels during and after treatment with cytotoxic chemotherapy combined with celecoxib or placebo. less thanbrgreater than less thanbrgreater thanMethods: In a previously published double-blind multicenter phase III trial, 316 patients with NSCLC stage IIIB or IV and World Health Organisation (WHO) performance status 0-2 were randomised to receive celecoxib 400 mg b.i.d. or placebo in combination with two-drug platinum-based chemotherapy. Chemotherapy cycle length was three weeks and planned duration of chemotherapy was four cycles. Celecoxib was given for a maximum of one year but was stopped earlier in case of disease progression or prohibitive toxicity. In a subset of patients, plasma VEGF levels were examined at onset of treatment and at 6, 12 and 20 weeks. less thanbrgreater than less thanbrgreater thanResults: VEGF levels at start of treatment were obtained in 107 patients at four study sites. The median value was 70 pg/ml. Mean values declined during the first 12 weeks and then increased at 20 weeks. A subpopulation treatment effect pattern plot (STEPP) analysis showed an inverse relationship between initial plasma VEGF and the impact of celecoxib on survival with zero effect at 200 pg/ml. The effect on survival by celecoxib in the whole subset of patients was positive (hazard ratio (HR)=0.64 [confidence interval (CI) 0.43-0.95], p=0.028). less thanbrgreater than less thanbrgreater thanConclusion: Low pretreatment plasma levels of VEGF appear to be predictive of a positive effect of celecoxib on survival.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Non-small cell lung cancer, Celecoxib, Chemotherapy, Survival, Plasma VEGF
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-88362 (URN)10.1016/j.ejca.2012.07.032 (DOI)000312896700015 ()
Note

Funding Agencies|Ostergotland County Council, Medical Research Council of South-East Sweden (FORSS)||

Available from: 2013-02-04 Created: 2013-02-04 Last updated: 2017-12-06
Koch, A., Gustafsson, B., Fohlin, H. & Sörenson, S. (2011). Cyclooxygenase-2 expression in lung cancer cells evaluated by immunocytochemistry. Diagnostic Cytopathology, 39(3), 188-193
Open this publication in new window or tab >>Cyclooxygenase-2 expression in lung cancer cells evaluated by immunocytochemistry
2011 (English)In: Diagnostic Cytopathology, ISSN 8755-1039, E-ISSN 1097-0339, Vol. 39, no 3, p. 188-193Article in journal (Refereed) Published
Abstract [en]

Cyclooxygenase-2 (COX-2) expression may be a prognostic factor in lung cancer. In previous studies, COX-2 expression has almost exclusively been evaluated with immunohistochemical methods performed on histology sections of tissue biopsies. However, in clinical practice, lung cancer is often diagnosed with cytological techniques only. We present methodology and results from analysis of COX-2 expression with immunochemistry on cytological material in 53 patients with lung cancer. Preparation and staining with the method established at our laboratory were easy to perform and resulted in good quality slides. The percentage COX-2-stained cells and the intensity of staining varied widely between and within the different cases. The proportion of positively stained tumor cells was as follows: <1% in 20 patients, 1-10% in 7 patients, 11-50% in 17 patients, and more than 50% in 9 patients. In 17 cases, groups of cells with different intensity of COX-2 staining were found in the same slide. In conclusion, immunocytochemical analysis of COX-2 expression is technically easy to perform with routine diagnostic procedures. There is a great variation in the proportion of COX-2-positive cells among patients and in the intensity of staining among individual cells in many single cases. Diagn. Cytopathol.2011;39:188-193. © 2010 Wiley-Liss, Inc.

Place, publisher, year, edition, pages
John Wiley and Sons, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-66083 (URN)10.1002/dc.21366 (DOI)000288035400006 ()21319320 (PubMedID)
Available from: 2011-03-04 Created: 2011-03-02 Last updated: 2017-12-11Bibliographically approved
Khoshnoud, M. R., Lofdahl, B., Fohlin, H., Fornander, T., Stål, O., Skoog, L., . . . Nordenskjöld, B. (2011). Immunohistochemistry compared to cytosol assays for determination of estrogen receptor and prediction of the long-term effect of adjuvant tamoxifen. Breast Cancer Research and Treatment, 126(2), 421-430
Open this publication in new window or tab >>Immunohistochemistry compared to cytosol assays for determination of estrogen receptor and prediction of the long-term effect of adjuvant tamoxifen
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2011 (English)In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 126, no 2, p. 421-430Article in journal (Refereed) Published
Abstract [en]

The purpose of this study is to compare immunohistochemistry (IHC) and cytosol-based assays for determination of estrogen receptor (ER) and prediction of response to adjuvant tamoxifen treatment in postmenopausal women with early-stage invasive breast cancer. The Stockholm Breast Cancer Study Group conducted a randomized trial during 1976 through 1990 comparing adjuvant tamoxifen versus control. The patients were stratified according to tumor size and lymph node status in high-risk and low-risk groups. In this study we evaluated 683 patients with “low risk” breast cancer (size ≤30 mm, lymph node-negative) for whom ER status had been determined by both the cytosol assays and IHC at one pathology laboratory. The median follow-up was 17 years. Six hundred eighty-three patients had tumors with ER determined by both methods, 536 (78.5%) were ER-positive by cytosol assays using the cutoff level at ≥0.05 fmol/μg DNA and 539 patients were ER-positive (79%) by IHC using the cutoff level at ≥10% cell stained. Thirty-nine tumors (5.7%) were ER-positive by cytosol but not by IHC, whereas the opposite pattern was found for 42 cases (6.1%). Only seven tumors had stained cells between 0 and 9% by IHC. The concordance between IHC and cytosol assays was high (88%). The kappa statistic was 0.65, 95% CI 0.58–0.72. Among patients classified as ER-negative no therapeutic benefit from tamoxifen was observed. Among patients with ER-expressing tumors, tamoxifen resulted in significantly better recurrence-free survival irrespective of the method (IHC: HR, 0.53, P < 0.001; cytosol: HR, 0.53, P < 0.001). The effect on overall survival was not statistically significant probably due to the limited sample size. Both IHC and cytosol assay accurately predict long-term response to adjuvant tamoxifen.

Place, publisher, year, edition, pages
Springer Science Business Media, 2011
Keywords
Breast cancer, Estrogen receptor, Tamoxifen, Cytosol, Immunohistochemical
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-67030 (URN)10.1007/s10549-010-1202-7 (DOI)000288251000014 ()
Available from: 2011-03-25 Created: 2011-03-25 Last updated: 2017-12-11
Tabar, L., Vitak, B., Hsiu-Hsi Chen, T., Ming-Fang Yen, A., Cohen, A., Tot, T., . . . Duffy, S. W. (2011). Swedish Two-County Trial: Impact of Mammographic Screening on Breast Cancer Mortality during 3 Decades. Radiology, 260(3), 658-663
Open this publication in new window or tab >>Swedish Two-County Trial: Impact of Mammographic Screening on Breast Cancer Mortality during 3 Decades
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2011 (English)In: Radiology, ISSN 0033-8419, E-ISSN 1527-1315, Vol. 260, no 3, p. 658-663Article in journal (Refereed) Published
Abstract [en]

Purpose: To estimate the long-term (29-year) effect of mammographic screening on breast cancer mortality in terms of both relative and absolute effects. less thanbrgreater than less thanbrgreater thanMaterials and Methods: This study was carried out under the auspices of the Swedish National Board of Health and Welfare. The board determined that, because randomization was at a community level and was to invitation to screening, informed verbal consent could be given by the participants when they attended the screening examination. A total of 133 065 women aged 40-74 years residing in two Swedish counties were randomized into a group invited to mammographic screening and a control group receiving usual care. Case status and cause of death were determined by the local trial end point committees and, independently, by an external committee. Mortality analysis was performed by using negative binomial regression. less thanbrgreater than less thanbrgreater thanResults: There was a highly significant reduction in breast cancer mortality in women invited to screening according to both local end point committee data (relative risk [RR] = 0.69; 95% confi dence interval: 0.56, 0.84; P andlt;.0001) and consensus data (RR = 0.73; 95% confi dence interval: 0.59, 0.89; P =.002). At 29 years of follow-up, the number of women needed to undergo screening for 7 years to prevent one breast cancer death was 414 according to local data and 519 according to consensus data. Most prevented breast cancer deaths would have occurred (in the absence of screening) after the first 10 years of follow-up. less thanbrgreater than less thanbrgreater thanConclusion: Invitation to mammographic screening results in a highly significant decrease in breast cancer-specific mortality. Evaluation of the full impact of screening, in particular estimates of absolute benefit and number needed to screen, requires follow-up times exceeding 20 years because the observed number of breast cancer deaths prevented increases with increasing time of follow-up.

Place, publisher, year, edition, pages
Radiological Society of North America (RSNA), 2011
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-70525 (URN)10.1148/radiol.11110469 (DOI)000293944700006 ()
Note
Funding Agencies|American Cancer Society||Available from: 2011-09-12 Created: 2011-09-12 Last updated: 2017-12-08
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