programas cribado cancer


Nota Bibliográfica

Esta Nota es una recopilación de publicaciones (artículos, informes, libros) sobre cribado de cáncer resultado de una revisión no sistemática de la literatura.

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Josep A Espinás. Pla Director d'Oncología de Catalunya.
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Nota bibliográfica cribado c mama 2014-11

Lousdal ML, Kristiansen IS, Møller B, Støvring H. Trends in breast cancer stage distribution before, during and after introduction of a screening programme in Norway. Eur J Public Health. 2014;24(6):1016–21. Available from:

Conclusion: Incidence of localized breast cancer increased significantly among women aged 50–69 years old after introduction of screening, while the incidence of more advanced cancers was not reduced in the same period when compared to the younger unscreened age group.

Andersen SB, Törnberg S, Lynge E, Von Euler-Chelpin M, Njor SH. A simple way to measure the burden of interval cancers in breast cancer screening. BMC Cancer. London; 2014;14(1):782. Available from: doi: 10.1186/1471-2407-14-782.

CONCLUSION: This alternate measure seems to capture the burden of interval cancers just as well as the traditional PICR, without need for the increasingly difficult estimation of background incidence, making it a more accessible tool when evaluating mammography screening program performance.

AL Mousa DS, Mello-Thoms C, Ryan EA, Lee WB, Pietrzyk MW, Reed WM, et al. Mammographic Density and Cancer Detection: Does Digital Imaging Challenge our Current Understanding?. Acad Radiol. 2014;21(11):1377–85. Available from: doi:

Conclusions Increased mammographic density improves the performance of experienced radiologists when using digital mammograms. This finding, which does not align with those previously reported for film screen systems, may be because of windowing/leveling opportunities available with digital images.

WHO. WHO position paper on mammography screening. Geneva:Switzerland; 2014.
Recommendations by age group and resource setting 1. Women aged 50−69 years 1.1 Well-resourced settings In well-resourced settings, WHO recommends 1 organized, populationbased mammography screening programmes for women aged 50−69 years if the conditions for implementing an organized programme specified in this guide 2 are met by the health-care system, and if shared decisionmaking strategies are implemented so that women’s decisions are consistent with their values and preferences. (Strong recommendation based on moderate quality evidence) WHO suggests a screening interval of two years. (Conditional recommendation based on low quality evidence) 1.2 Limited resource settings with relatively strong health systems In limited resource settings with relatively strong health systems, WHO suggests 3 considering an organized, population-based mammography screening programme for women aged 50−69 years only if the conditions for implementing an organized programme specified in this guide 4 are met by the health-care system, and if shared decision-making strategies are implemented so that women’s decisions are consistent with their values and preferences. (Conditional recommendation based on moderate quality evidence) WHO suggests a screening interval of two years. (Conditional recommendation based on low quality evidence) 1.3 Limited resource settings with weak health systems In limited resource settings with weak health systems, where the majority of women with breast cancer are diagnosed in late stages and mammography screening is not cost-effective and feasible, early diagnosis of breast cancer through universal access of women with symptomatic lesions to prompt and effective diagnosis and treatment should be high 1. According to GRADE, “recommend” is used when there is a strong recommendation. 2. See Box 1, page 8. 3. According to GRADE, “suggest” is used when there is a conditional recommendation. 4. See Box 1, page 8. 12 WHO position paper on mammography screening on the public health agenda (WHO, 2013). Clinical breast examination, a low-cost screening method, seems to be a promising approach for these settings and could be implemented when the necessary evidence from ongoing studies becomes available (Sankaranarayanan et al., 2011). 2. Women aged 40−49 years 2.1 Well-resourced settings In well-resourced settings, WHO suggests an organized, population-based screening programme for women aged 40−49 years only if such programme is conducted in the context of…

Tabár L, Yen AM-F, Wu WY-Y, Chen SL-S, Chiu SY-H, Fann JC-Y, et al. Insights from the Breast Cancer Screening Trials: How Screening Affects the Natural History of Breast Cancer and Implications for Evaluating Service Screening Programs. Breast J. 2014;n/a – n/a. Available from: doi: 10.1111/tbj.12354.

This study provides evidence that the average mortality reduction in all the trials underestimates the true mortality reduction, and that substantially greater breast cancer mortality reductions can be expected in screening programs that are effective in reducing advanced stage breast cancer. In addition, monitoring the incidence of advanced stage breast cancer in an ongoing screening program can provide a sensitive and early indicator of the subsequent mortality from the disease.

Bargallo X, Santamaria G, Del Amo M, Arguis P, Rios J, Grau J, et al. Single reading with computer-aided detection performed by selected radiologists in a breast cancer screening program.Eur J Radiol. Ireland; 2014;83(11):2019–23. doi: 10.1016/j.ejrad.2014.08.010. PMID: 25193778.

CONCLUSIONS: The cancer detection rate of the screening program improved using a single reading protocol by experienced radiologists assisted by CAD, at the cost of a moderate increase of the recall rate mainly related to the lack of arbitration.

Altobelli E, Lattanzi A. Breast cancer in European Union: an update of screening programmes as of March 2014 (review). Int J Oncol. Greece; 2014;45(5):1785–92. doi: 10.3892/ijo.2014.2632. PMID: 25174328.

 Breast cancer, a major cause of female morbidity and mortality, is a global health problem; 2008 data show an incidence of ~450,000 new cases and 140,000 deaths (mean incidence rate 70.7 and mortality rate 16.7, world age-standardized rate per 100,000 women) in European Union Member States. Incidence rates in Western Europe are among the highest in the world. We review the situation of BC screening programmes in European Union. Up to date information on active BC screening programmes was obtained by reviewing the literature and searching national health ministries and cancer service websites. Although BC screening programmes are in place in nearly all European Union countries there are still considerable differences in target population coverage and age and in the techniques deployed. Screening is a mainstay of early BC detection whose main weakness is the rate of participation of the target population. National policies and healthcare planning should aim at maximizing participation in controlled organized screening programmes by identifying and lowering any barriers to adhesion, also with a view to reducing healthcare costs.


Nota bibliográfica cribado c mamal 2014-10

Vidal C, Garcia M, Benito L, Milà N, Binefa G, Moreno V. Use of Text-Message Reminders to Improve Participation in a Population-Based Breast Cancer Screening Program. J Med Syst. New York; 2014;38(9):1–118. Available from: doi:

To analyze the effect of a cell text message reminder service on participation in a mammogram screening program in Catalonia, Spain. A quasi-experimental design was used with women aged 50 to 69 years who had been scheduled mammogram appointments in June or July 2011. Women were personally invited by letter to attend to the breast cancer screening program (n=12,786). Prior to the invitation, 3,719 (29.1 %) of them had provided their cell telephone number to the National Health Service. These women received a text message reminder 3 days before their scheduled appointment. Logistic regression models were used to analyze whether the text message reminder was associated with participation in screening. Cost-effectiveness of adding a text message reminder to the invitation letter was also analyzed. The overall rate of participation in breast cancer screening was 68.4 %. The participation rate was significantly higher in the text messaging group, with an age-adjusted OR of 1.56 (95 %CI: 1.43-1.70). A detailed analysis showed that the increase in participation related to the text message reminder was higher among women without previous screening who lived in areas where access to postal mail was limited (OR=2.85; 95 %CI: 2.31-3.53) compared to those who lived in areas of easier postal mail access (OR=1.66; 95 %CI: 1.36-2.02). The invitation letter+text message reminder was a cost-effective strategy. Text message reminders are an efficient cost-effective approach to improve participation in difficult-to-reach populations, such as rural areas and newly developed suburbs.

Tupper R, Holm K. Screening Mammography and Breast Cancer Reduction: Examining the Evidence. J Nurse Pract. 2014;10(9):721–8. Available from: doi:

Better treatment and awareness may explain much of the decline in breast cancer deaths in recent years, not mammography. For women without a family history of breast cancer, the risks of screening mammography may outweigh the benefits, particularly for women younger than age 50. Mammography carries the risk of overdiagnosis of tumors that would not have caused death. Nurse practitioners are advised to educate their patients on mammography risks and benefits while increasing their emphasis on the clinical symptoms of breast cancer and ways to reduce risk, including weight control, decreased alcohol use, and decreased use of menopausal estrogen


Nota bibliográfica cribado c mama 2014-09

Natal C, Caicoya M, Prieto M, Tardón A. Incidencia de cáncer de mama en relación con la participación en un programa de cribado poblacional. Med Clin (Barc). 2014;(x). Available from: doi: 10.1016/j.medcli.2014.04.028.

Ascunce N. Sobrediagnóstico en programas de cribado de cáncer de mama: un efecto adverso inevitable que debe tenerse en cuenta. Med Clin (Barc). 2014;(x). Available from: doi: 10.1016/j.medcli.2014.07.017. PMID: 25178546.

Heinävaara S, Sarkeala T, Anttila A. Overdiagnosis due to breast cancer screening: updated estimates of the Helsinki service study in Finland. Br J Cancer. 2014;111(7):1463–8. Available from: doi: 10.1038/bjc.2014.413. PMID: 25121953.

Conclusions:Our estimates of overdiagnosis are of the same magnitude than other plausible estimates in Europe. Both alternative approaches produced similar estimates for the expected cumulative incidence, which increased the confidence in the estimates of overdiagnosis.

Overdiagnosis from mammographic screening. Position Statment. 2014.
Summary Cancer Australia supports the importance of mammographic screening in reducing breast cancer mortality. The national BreastScreen Australia Evaluation indicated a reduction in breast cancer mortality for the age group of 50-69 years of approximately 21-28% at the participation level of 56%. Participation in the BreastScreen Australia Program would result in around 8 deaths prevented for every 1000 women screened every two years from age 50 to age 74. A majority of breast cancers found through screening would be progressive and would become symptomatic within a woman’s lifetime if left untreated. It is likely that some screen-detected breast cancers (ductal carcinoma in situ or invasive breast cancer) might never have progressed to become symptomatic in a woman’s lifetime. Detection of these cancers is sometimes referred to as “overdiagnosis”. It is not possible to precisely predict at diagnosis, to which cancers overdiagnosis would apply. Estimates of overdiagnosis vary widely. Based on UK and European reviews, it is estimated that for every 1000 women in Australia who are screened every two years from age 50 to age 74, around 8 (between 2 and 21) breast cancers may be found and treated that would not have been found in a woman’s lifetime. Research is needed, including molecular and genomic research, to find means of identifying cancers that would be of minimal risk of progression and therefore could be managed more conservatively.

Bell RJ. Screening mammography - early detection or over-diagnosis? Contribution from Australian data. Climacteric. 2014;1–7. Available from: doi: 10.3109/13697137.2014.956718. PMID: 25224048.

Conclusions The benefits and harms of screening mammography are finely balanced. The impact of screening mammography is at best neutral but may result in overall harm. Women should be informed of the issue of over-diagnosis. It is time to review whether organized mammographic screening programs should continue.

Waller J, Whitaker KL, Winstanley K, Power E, Wardle J. A survey study of women’s responses to information about overdiagnosis in breast cancer screening in Britain. Br J Cancer. 2014;(August):1–5. Available from: doi: 10.1038/bjc.2014.482. PMID: 25167224.

Conclusions:Brief written information on overdiagnosis was incompletely understood, but reduced breast screening intentions in a proportion of women, regardless of comprehension. Subjective comprehension was lower among women who had not yet reached screening age but the deterrent effect was higher.British Journal of Cancer advance online publication, 28 August 2014; doi:10.1038/bjc.2014.482

Munoz D, Near AM, van Ravesteyn NT, Lee SJ, Schechter CB, Alagoz O, et al. Effects of Screening and Systemic Adjuvant Therapy on ER-Specific US Breast Cancer Mortality. J Natl Cancer Inst. 2014;106(11). Available from: doi: 10.1093/jnci/dju289.

Conclusion As advances in risk assessment facilitate identification of women with increased risk of ER-negative breast cancer, additional mortality reductions could be realized through more frequent targeted screening, provided these benefits are balanced against screening harms.

Coldman A, Phillips N, Wilson C, Decker K, Chiarelli AM, Brisson J, et al. Pan-Canadian Study of Mammography Screening and Mortality from Breast Cancer. J Natl Cancer Inst. 2014;106(11). Available from: doi: 10.1093/jnci/dju261.

Conclusion Participation in mammography screening programs in Canada was associated with substantially reduced breast cancer mortality


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