Cancer Causes & Control

, Volume 21, Issue 10, pp 1569–1573 | Cite as

A remarkable reduction of breast cancer deaths in screened versus unscreened women: a case-referent study

  • Ellen PaapEmail author
  • Roland Holland
  • Gerard J. den Heeten
  • Guido van Schoor
  • Anita A. M. Botterweck
  • André L. M. Verbeek
  • Mireille J. M. Broeders
Original paper



We designed a case-referent study to investigate the effect of mammographic screening at the individual level, looking at the association of breast cancer death with screening history.


The study population included all women aged 50–75 in the province of Limburg, the Netherlands who had been invited to the screening program from 1989 to 2006. From this population, 118 cases originated who died of breast cancer in 2004 or 2005. The screening history of these cases was collected and compared with a sample of the invited population. The breast cancer death rate in the screened relative to the unscreened women was estimated as the odds ratio (OR). This OR was adjusted for self-selection bias, the difference in baseline risk for breast cancer death between screened and unscreened women.


Analysis of the data showed a breast cancer mortality reduction of 70% in the screened versus the unscreened women (OR = 0.30, 95% CI 0.14–0.63). The magnitude of self-selection was estimated specifically for Limburg. After correction for self-selection bias, the effect of screening increased to 76% (OR = 0.24, 95% CI 0.10–0.58).


Screening resulted in a remarkable reduction in breast cancer mortality. Contrary to findings in other countries, adjustment for self-selection in Limburg had no influence on the impact of screening. Thanks to a well-organized centralized screening program, similar results are expected in other regions of the Netherlands.


Breast cancer Service screening Case-referent study 



This study was funded by a grant from the Dutch Cancer Society (project number: KUN 2006-3571). The funding source had no involvement in the study. We thank both the Comprehensive Cancer Centre Limburg and Statistics Netherlands for providing the data for this study. We thank Roger Staats for his contribution to this paper as a medical writer. He works at “Radboud in’ to Languages” Radboud University Nijmegen.

Conflict of interest

We declare that we have no conflicts of interest.


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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Ellen Paap
    • 1
    Email author
  • Roland Holland
    • 2
  • Gerard J. den Heeten
    • 2
  • Guido van Schoor
    • 1
  • Anita A. M. Botterweck
    • 3
  • André L. M. Verbeek
    • 1
    • 2
  • Mireille J. M. Broeders
    • 1
    • 2
  1. 1.Department of EpidemiologyBiostatistics and HTA, Radboud University Nijmegen Medical CentreNijmegenThe Netherlands
  2. 2.National Expert and Training Centre for Breast Cancer Screening, Radboud University Nijmegen Medical CentreNijmegenThe Netherlands
  3. 3.Comprehensive Cancer Centre LimburgMaastrichtThe Netherlands

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