Breast Cancer Research and Treatment

, Volume 18, Issue 1, pp 49–56 | Cite as

Randomized study of mammography screening — preliminary report on mortality in the stockholm trial

  • J. Frisell
  • G. Eklund
  • L. Hellström
  • E. Lidbrink
  • L. -E. Rutqvist
  • A. Somell

Summary

In March 1981, 40,318 women in Stockholm, aged 40–64, entered a randomized trial of breast cancer screening by single-view mammography alone versus no intervention in a control group of 20,000 women. The attendance rate during the first screening round was 81 per cent and the cancer detection rate was 4.0 per 1000 women. The detection the rate fell to 3.1 per 1000 in the second round, which was completed in October 1985. During 1986 the controlled design of the study was broken and the contro women were invited once to screening which was completed the same year. A total of 428 cases of breast cancer were thus diagnosed in the study group and 439 in the adjusted control group. After a mean follow-up of 7.4 years the number of breast cancer deaths in the study and control groups was 39 and 30 respectively. The relative risk of breast cancer death (screening versus control) was 0.71 (95 per cent confidence interval: 0.4–1.2). Among women older than 50 years at entry the relative risk was 0.57 (95 per cent confidence interval: 0.3–1.1). Cancer deaths among women under 50 were few and perhaps because of this no mortality reduction was seen in this age group. The estimate of mortality reduction lies between the results from two earlier Swedish randomized controlled trials.

Key words

breast cancer mammography screening mortality 

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References

  1. 1.
    Shapiro S, Strax Ph, Venet L: Periodic breast cancer screening in reducing mortality from breast cancer. JAMA 215: 1777–1785, 1971CrossRefPubMedGoogle Scholar
  2. 2.
    Colette HJA, Day NE, Rombach JJ, de Waard F: Evaluation of screening for breast cancer in a non-randomized study (the DOM-project) by means of a case-control study. Lancet i: 1224–1226, 1984CrossRefGoogle Scholar
  3. 3.
    Verbeek ALM, Holland R, Sturmans F, Hendriks JHCL, Mravunac M, Day NE: Reduction of breast cancer mortality through mass screening with modern mammography. Lancet i: 1222–1224, 1984CrossRefGoogle Scholar
  4. 4.
    UK Breast Cancer Detection Working Group: Trial of early detection of breast cancer: Description of method. Br J Cancer 44: 618–627, 1981Google Scholar
  5. 5.
    Chamberlain J, Coleman D, Ellman R, Moss SM: First results on mortality reduction in the UK trial of early detection of breast cancer. Lancet ii: 411–416, 1988Google Scholar
  6. 6.
    Roberts MM, Alexander FE, Anderson TJ, Chetty U, Donnan PT, Forrest P, Hepburn W, Huggins A, Kirkpatrick AE, Lamb J, Muir BB, Prescott RJ: Edinburgh trial of screening for breast cancer: mortality at seven years. Lancet 335: 241–246, 1990CrossRefPubMedGoogle Scholar
  7. 7.
    Tabár L, Fagerberg G, Gad A, Baldetorp L, Holmberg LH, Gröntoft D, Ljungqvist U, Lundström B, Månsson IC, Eklund G, Pettersson F, Day NE: Reduction in mortality from breast cancer after mass screening with mammography. Lancet i: 829–832, 1985CrossRefGoogle Scholar
  8. 8.
    Andersson I, Aspegren U, Janzon L, Landberg T, Lindholm K, Linell F, Ljungberg O, Ranstam J, Sigfüsson B: Mammographic screening and mortality from breast cancer: the Malmö mammographic screening trial. Br Med J 297: 943–948, 1988Google Scholar
  9. 9.
    Frisell J, Glas U, Hellström L, Somell A: Randomized mammographic screening for breast cancer in Stockholm. Breast Cancer Res Treat 8: 45–54, 1986PubMedGoogle Scholar
  10. 10.
    Frisell J, Eklund G, Hellström L, Glas U, Somell A: The Stockholm breast cancer screening trial — 5-year results and stage at discovery. Breast Cancer Res Treat 13: 79–87, 1989PubMedGoogle Scholar
  11. 11.
    World Health Organisation: Manual of international statistical classification of disease, injuries, and cases of death; based on the recommendations of the eighth revision conference, 1965, and adopted by the nineteenth world health assembly. Geneva: WHO, 1969Google Scholar
  12. 12.
    Tabár L, Gad A: Screening for breast cancer: The Swedish trial. Radiology 138: 219–222, 1981PubMedGoogle Scholar
  13. 13.
    Andersson I: Radiographic screening for breast carcinoma. Program and primary findings in 45–69 year old women. Acta Radiol (Diagn) 22: 185–194, 1981Google Scholar
  14. 14.
    Tabár L, Fagerberg G, Day NE, Holmberg L: What is the optimum interval between mammographic screening examinations? — An analysis based on the latest results of the Swedish two-county breast cancer screening trial. Br J Cancer 55: 547–551, 1987PubMedGoogle Scholar
  15. 15.
    Frisell J, Eklund G, Hellström L, Somell A: Analysis of interval breast carcinomas in a randomized screening trial in Stockholm. Breast Cancer Res Treat 9: 219–225, 1987CrossRefPubMedGoogle Scholar
  16. 16.
    Gad A, Thomas BA, Moskowitz M: Screening for breast cancer in Europe: achivements, problems and future. Recent Results Cancer Res 90: 179–194, 1984PubMedGoogle Scholar
  17. 17.
    Rosen PP, Groshen S, Saigo PE, Kinne DW, Hellman S: A long-term follow-up study of survival in stage I (T1N0M0) and stage II (T1N1M0) breast carcinoma. J Clin Oncol 7: 355–366, 1989PubMedGoogle Scholar
  18. 18.
    Fournier O, Weber E, Hoeffken W, Baner M, Kubbi F, Barth V: Growth rate of 147 mammary carcinomas. Cancer 45: 2198–2207, 1980PubMedGoogle Scholar
  19. 19.
    Rutqvist LE, Wallgren A, Nilsson B: Is breast cancer a curable disease? A study of 14,731 women with breast cancer from the Cancer Registry of Norway. Cancer 53: 1793–1800, 1984PubMedGoogle Scholar
  20. 20.
    Tabár L, Gad A, Holmberg L, Ljungqvist U: Significant reduction in advanced breast cancer. Diagn Imag Clin Med 54: 158–164, 1985Google Scholar
  21. 21.
    Fagerberg G, Baldetorp L, Gröntoft O, Lundström B, Månsson JC, Nordenskjöld B: Effects of repeated mammographic screening on breast cancer stage distribution. Acta Radiologica 24: 465–473, 1985Google Scholar
  22. 22.
    Tabár L, Fagerberg CJG, Day NE: The results of periodic one-view mammography screening in a randomized, controlled trial in Sweden, Part 2: Evaluation of the results. In: Day NE, Miller AB (eds) Screening for breast cancer. UICC Technical Report Series, Geneva, 1988, pp 39–44Google Scholar
  23. 23.
    Tabár L, Fagerberg G, Duffy SW, Day NE: The Swedish two county trial of mammographic screening for breast cancer: recent results and calculations of benefit. J Epidemiol Community Health 43: 107–114, 1989PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1991

Authors and Affiliations

  • J. Frisell
    • 1
  • G. Eklund
    • 4
  • L. Hellström
    • 2
  • E. Lidbrink
    • 3
  • L. -E. Rutqvist
    • 5
  • A. Somell
    • 1
  1. 1.Department of Surgery, SödersjukhusetStockholmSweden
  2. 2.Department of Radiology, SödersjukhusetSweden
  3. 3.Department of Oncology, SödersjukhusetSweden
  4. 4.Department of Cancer EpidemiologyKarolinska HospitalStockholmSweden
  5. 5.Department of OncologyKarolinska HospitalStockholmSweden

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