programas cribado cancer

Nota bibliográfica cribado c mama 2014-01

Puig-Vives M, Osca-Gelis G, Camprubí-Font C, Vilardell ML, Izquierdo A, Marcos-Gragera R. Proporción de cáncer de mama en mujeres de 50 a 69 años de Girona según el método de detección. Med Clin (Barc). (0). Available from: doi:

Conclusiones Durante los primeros años del funcionamiento del PDPCM (2002-2006) los casos de cáncer de intervalo representaron un porcentaje bajo (5,8%) respecto el total de CM diagnosticados en mujeres de 50 a 69 años en la provincia de Girona.

García Fernández A, Chabrera C, García Font M, Fraile M, Lain JM, Gónzalez S, et al. Mortality and recurrence patterns of breast cancer patients diagnosed under a screening programme versus comparable non-screened breast cancer patients from the same population: analytical survey from 2002 to 2012. Tumour Biol. 2013; Available from: doi: 10.1007/s13277-013-1260-7. PMID: 24114015.

 Breast cancer screening programmes seem to bring about significant benefits, including decreased mortality, although they may also have some drawbacks such as false-negative and false-positive results. This study aims to compare the clinical outcome of a group of patients undergoing a breast cancer screening programme with that of a synchronous non-screened group of patients matched for age and follow-up period. We studied basic characteristics of epidemiology, immunohistochemistry, loco-regional relapse, distant metastases, disease-free interval and overall and specific mortality. We compared 510 patients in the screened group with 394 non-screened patients, along the period of 2002-2012. Screening was applied on a target population of 49,847 and was based on double-projection, double-read mammograms. Two years were allowed per round. Overall participation for the five rounds considered was 75.2 %, with 86.5 % coverage, and a total cumulative population of 123,445. The non-participant women amounted 40,794. Tumour detection rate for the screened women was 3.8 per thousand (475/123,445), while the corresponding rate for non-participants was 9.4 per thousand (382/40,797). Incidence of luminal A subtype was 15 % higher in screened than that in non-screened patients (95 % confidence interval (CI) 8-22 %). Conversely, the triple-negative subtype was 6 % higher in the non-screened group (95 % CI 2-10 %). Incidence of breast conservative treatments and sentinel node biopsies was significantly higher in the screened group. Overall mortality was 2.6 times higher in non-screened than that in screened group (95 % CI 1.2-5.6) After 10 years of experience with our own screening programme, we believe that included patients receive a benefit versus comparable non-screened breast cancer patients, with acceptable benefit-risk relation.

MA S, Hamel M, RB D, Al E. Development and evaluation of a decision aid on mammography screening for women 75 years and older. JAMA Intern Med. 2013; Available from:

CONCLUSIONS: A DA may improve older women’s decision making about
mammography screening.

Rafferty EA, Park JM, Philpotts LE, Poplack SP, Sumkin JH, Halpern EF, et al. Diagnostic Accuracy and Recall Rates for Digital Mammography and Digital Mammography Combined With One-View and Two-View Tomosynthesis: Results of an Enriched Reader Study. Am J Roentgenol. 2014;202(2):273–81. Available from: doi: 10.2214/AJR.13.11240.

CONCLUSION. The addition of one-view tomosynthesis to conventional digital mammography improved diagnostic accuracy and reduced the recall rate; however, the addition of two-view tomosynthesis provided twice the performance gain in diagnostic accuracy while further reducing the recall rate.

Plecha D, Salem N, Kremer M, Pham R, Downs-Holmes C, Sattar A, et al. JOURNAL CLUB: Neglecting to Screen Women Between 40 and 49 Years Old With Mammography: What Is the Impact on Treatment Morbidity and Potential Risk Reduction? Am J Roentgenol. 2014;202(2):282–8. Available from: doi: 10.2214/AJR.13.11382.

CONCLUSION. In addition to the benefits of receiving a diagnosis at earlier stages, with smaller tumors and node negativity, patients with breast cancer undergoing screening mammography aged 40?49 years are less likely to require chemotherapy and its associated morbidities. The majority of high-risk lesions were diagnosed in the screened group, which may lead to the benefit of chemoprevention, lowering their risk of subsequent breast cancer, or screening with MRI, which may diagnose future mammographically occult malignancies.

Javitt MC. Section Editor’s Notebook: Breast Cancer Screening and Overdiagnosis Unmasked. Am J Roentgenol. 2014;202(2):259–61. Available from: doi: 10.2214/AJR.13.12052.

Kopans DB. Digital Breast Tomosynthesis From Concept to Clinical Care. Am J Roentgenol. 2014;202(2):299–308. Available from: doi: 10.2214/AJR.13.11520.

CONCLUSION. Mammographic screening has dramatically reduced breast cancer deaths, but it does not depict all cancer early enough to result in a cure. In addition, because of the recall rates associated with mammography, efforts are underway to reduce access to screening. Use of DBT improves sensitivity and specificity, and there is no longer a need to obtain full-exposure 2D mammograms. DBT will replace standard 2D mammography for breast cancer screening.

Ceugnart L, Deghaye M, Vennin P, Haber S, Taieb S. Organized breast screening: Answers to recurring controversies. Diagn Interv Imaging. (0). Available from: doi:

Abstract The reduction in mortality specifically from breast cancer, demonstrated in the major meta-analyses in the 1980s resulted in public health breast cancer screening programs being set up in many countries, including France. Recent publications have challenged the usefulness of screening, by insisting in particular on the negative effects of overdiagnosis and the lack of any significant impact on mortality. From analysis of the literature and particularly independent reviews published in 2012, we provide some answers for doctors faced with the legitimate concerns of women. These studies confirm that screening in the right age group reduces specific mortality by at least 20% at a cost of overdiagnosis estimated at between 1 and 15%.

Welch H, HJ P. Quantifying the benefits and harms of screening mammography. JAMA Intern Med. 2013; Available from:

 Like all early detection strategies, screening mammography involves trade-offs. If women are to truly participate in the decision of whether or not to be screened, they need some quantification of its benefits and harms. Providing such information is a challenging task, however, given the uncertainty—and underlying professional disagreement—about the data. In this article, we attempt to bound this uncertainty by providing a range of estimates—optimistic and pessimistic—on the absolute frequency of 3 outcomes important to the mammography decision: breast cancer deaths avoided, false alarms, and overdiagnosis. Among 1000 US women aged 50 years who are screened annually for a decade, 0.3 to 3.2 will avoid a breast cancer death, 490 to 670 will have at least 1 false alarm, and 3 to 14 will be overdiagnosed and treated needlessly. We hope that these ranges help women to make a decision: either to feel comfortable about their decision to pursue screening or to feel equally comfortable about their decision not to pursue screening. For the remainder, we hope it helps start a conversation about where additional precision is most needed.

Health Council of the Netherlands. Health Council of the Netherlands. Population screening for breast cancer: expectations and developments. The Hague; 2014.

Health Council of the Netherlands. Population screening for breast cancer: expectations and developments. The Hague: Health Council of the Netherlands, 2014; publication no. 2014/01. ISBN 978-90-5549-991-5
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