Abstract
The purpose of this study is to critically appraise the claim by Nickson et al. [1] that they have evidence supporting the Australian Government’s recent decision to extend the national free invitation for biennial mammography program (BreastScreen) to women aged 70–74 years. Since their claim was made on the basis of a significant difference in the incidence of larger primary breast cancers between women in this age group who are already participating in BreastScreen versus those who are not, an analysis of the stage at diagnosis of breast cancer in the USA versus mammographic screening over 30 years, evidence from breast cancer adjuvant endocrine and chemotherapy (adjuvant therapy) trials and data from an evaluation of BreastScreen and adjuvant therapy use in Australia were examined. By 1999, most Australian women aged 40–79 years were receiving adjuvant therapy that could cure breast cancer no matter what the size of the primary cancer. Further, the incidence primary breast cancers of all sizes had doubled in the USA during 30 years of mammographic screening, but the incidence of more advanced breast cancers had almost remained constant, indicating that adjuvant therapy, not mammographic screening, was the main cause of the 28 % reduction in breast cancer mortality that had been observed. In conclusion, the claim by Nickson et al. is not supported by available evidence. Further, BreastScreen should not have been extended to these older women before the UK trial, which is testing the efficacy of mammographic screening of women aged 70–74 years [8], had reported its results.
References
Nickson C, Mason KE, Kavanagh AM (2014) Breast cancer screening of women aged 70–74 years: results from a natural experiment across Australia. Breast Cancer Res Treat 143:367–372
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. The Lancet 365(9472):1687–1717
Bleyer A, Welch HG (2012) Effect of three decades of screening mammography on breast cancer incidence. N Engl J Med 367(21):1998–2005
Hill DJ, Jamrozik K, White VM, Collins JP, Boyages J, Shugg D, Pruden M, Giles G, Byrne M (1999) Surgical management of breast cancer in Australia in 1995. National Breast Cancer Centre, Kings Cross NSW
White V, Pruden M, Giles G, Collins J, Jamrozik K, Inglis G, Boyages J, Hill D (2004) The management of early breast carcinoma before and after the introduction of clinical practice guidelines. Cancer 101(3):476–485
Burton RC, Bell RJ, Thiagarajah G, Stevenson C (2012) Adjuvant therapy, not mammographic screening, accounts for most of the observed breast cancer specific mortality reductions in Australian women since the national screening program began in 1991. Breast Cancer Res Treat 131(3):949–955
Australian Institute of Health and Welfare (AIHW). http://www.aihw.gov.au/collection-of-mortality-data/
ISRCTN Register UK evaluating the age extension of the NHS breast screening program. http://www.controlled-trials.com/ISRCTN33292440
Author information
Authors and Affiliations
Corresponding author
Additional information
A rebuttal letter to this letter to the editor is available at doi:10.1007/s10549-014-2952-4
Rights and permissions
About this article
Cite this article
Burton, R. Letter in response: breast cancer screening of women aged 70–74 years. Breast Cancer Res Treat 145, 563–564 (2014). https://doi.org/10.1007/s10549-014-2948-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-014-2948-0