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Tumor size and breast cancer detection: What might be the effect of a less sensitive screening tool than mammography?
Cancer Research UK Center for Epidemiology, Mathematics, and Statistics, Wolfson Institute of Preventive Medicine, London, United Kingdom, Department of Cancer Screening, Cancer Research UK Center for Epidemiology, Mathematics, and Statistics, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, United Kingdom.
Mammography Department, Central Hospital, Falun, Sweden.
Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology UHL.
Cancer Research UK Center for Epidemiology, Mathematics, and Statistics, Wolfson Institute of Preventive Medicine, London, United Kingdom.
2006 (English)In: The Breast Journal, ISSN 1075-122X, E-ISSN 1524-4741, Vol. 12, no SUPPL. 1Article in journal (Refereed) Published
Abstract [en]

In some limited-resource areas, a state-of-the-art mammography program is not affordable. In such circumstances, one might consider a less resource-intensive, but also less sensitive screening tool such as clinical breast examination (CBE). We used data from the Swedish Two-County Trial to estimate the shift in tumor size resulting from invitation to mammographic screening. By postulating a lesser benefit of a less sensitive screening tool (CBE), particularly in terms of detecting very small tumors, we predicted its likely effect on tumor size distribution. In addition, using the observed association between tumor size and nodal status, and between tumor size and fatality, we predicted the likely benefit in terms of reductions in node-positive disease and in breast cancer mortality. An invitation to mammographic screening was associated with a 27% reduction in the number of node-positive tumors and a 31% reduction in the number of breast cancer deaths. We estimate that in the trial population, screening with CBE alone would have led to an 11% reduction in node-positive tumors and an 11% reduction in breast cancer deaths (approximately 42 deaths prevented per 1000 cases). Assuming instead a tumor size distribution typical of a limited-resource setting (70% of tumors are 30 mm at presentation), we estimate that screening with CBE alone would lead to a 13% reduction in node-positive tumors and a 12% reduction in breast cancer deaths (approximately 72 deaths prevented per 1000 cases). Thus, although the relative benefit of CBE is only slightly greater in the limited-resource setting, the absolute reduction in deaths per case is about 70% higher. Our findings suggest that a less sensitive tool might be expected to confer a breast cancer mortality reduction about half of that observed with mammography. © 2006 The Fred Hutchinson Cancer Research Center.

Place, publisher, year, edition, pages
2006. Vol. 12, no SUPPL. 1
Keyword [en]
Breast cancer, Clinical breast examination, Early detection, Mammography, Mortality, Screening, Tumor size
National Category
Natural Sciences
Identifiers
URN: urn:nbn:se:liu:diva-50324DOI: 10.1111/j.1075-122X.2006.00207.xOAI: oai:DiVA.org:liu-50324DiVA: diva2:271220
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12

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