programas cribado cancer

Nota bibliográfica cribado c mama 2014-02

Miller AB, Wall C, Baines CJ, Sun P, To T, Narod SA. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial. BMJ. 2014;348. Available from:

Conclusion Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available. Overall, 22% (106/484) of screen detected invasive breast cancers were over-diagnosed, representing one over-diagnosed breast cancer for every 424 women who received mammography screening in the trial.

Kalager M, Adami H-O, Bretthauer M. Too much mammography. BMJ. 2014;348.

Yaffe MJ, Pritchard KI. Overdiagnosing Overdiagnosis. Oncologist. 2014;19(2):103–6. Available from: doi: 10.1634/theoncologist.2014-0036.

Christiansen P, Vejborg I, Kroman N, Holten I, Garne JP, Vedsted P, et al. Position paper: Breast cancer screening, diagnosis, and treatment in Denmark. Acta Oncol (Madr). 2014;1–12. Available from: doi: 10.3109/0284186X.2013.874573.
Breast cancer treatment in Denmark is evidence based and in agreement with international recommendations. After the introduction of mammography screening the absolute number of patients with a more advanced stage at diagnosis and the absolute number of patients undergoing mastectomy have decreased.

Kopans DB. Arguments Against Mammography Screening Continue to be Based on Faulty Science. Oncologist. 2014;19(2):107–12. Available from: doi: 10.1634/theoncologist.2013-0184.

Bleyer A. Were Our Estimates of Overdiagnosis With Mammography Screening in the United States “Based on Faulty Science”? Oncologist. 2014;19(2):113–26. Available from: doi: 10.1634/theoncologist.2013-0383.

Arie S. Switzerland debates dismantling its breast cancer screening programme. BMJ. 2014;348.

A row has erupted in Switzerland after the Swiss Medical Board recommended that the country’s mammography screening programme for breast cancer be suspended because it leads to too many unnecessary interventions.In a report made public on 2 February, the board said that while systematic mammography screening for breast cancer saved 1-2 women’s lives for every 1000 screened, it led to unnecessary investigations and treatment for around 100 women in every 1000.1“The desirable effect is offset by the undesirable effects,” said the report, which was based on study data from …

Latosinsky S, Bryant HE, Newman LA. FORMATION MÉDICALE CONTINUE CAGS AND ACS EVIDENCE BASED REVIEWS IN SURGERY . 48 . What is the effect of screening mammography on breast cancer incidence ? Contin Med Educ. 2014;57(1):67–9. doi: 10.1503/cjs.032913.

Dibden A, Offman J, Parmar D, Jenkins J, Slater J, Binysh K, et al. Reduction in interval cancer rates following the introduction of two-view mammography in the UK breast screening programme. Br J Cancer. 2014;110(3):560–4. Available from: doi: 10.1038/bjc.2013.778. PMID: 24366303.

Conclusion:The introduction of two-view mammography at incident screens is associated with a reduction in incidence of interval cancers. This is consistent with previous publications on a contemporaneous increase in screen-detected cancers. The results provide further evidence of the benefit of the use of two-view mammography at incident screens.

Vilaprinyo E, Forné C, Carles M, Sala M, Pla R, Castells X, et al. Cost-Effectiveness and Harm-Benefit Analyses of Risk-Based Screening Strategies for Breast Cancer. Sapino A, editor. PLoS One. 2014;9(2):e86858. Available from: doi: 10.1371/journal.pone.0086858.

The one-size-fits-all paradigm in organized screening of breast cancer is shifting towards a personalized approach. The present study has two objectives: 1) To perform an economic evaluation and to assess the harm-benefit ratios of screening strategies that vary in their intensity and interval ages based on breast cancer risk; and 2) To estimate the gain in terms of cost and harm reductions using risk-based screening with respect to the usual practice. We used a probabilistic model and input data from Spanish population registries and screening programs, as well as from clinical studies, to estimate the benefit, harm, and costs over time of 2,624 screening strategies, uniform or risk-based. We defined four risk groups, low, moderate-low, moderate-high and high, based on breast density, family history of breast cancer and personal history of breast biopsy. The risk-based strategies were obtained combining the exam periodicity (annual, biennial, triennial and quinquennial), the starting ages (40, 45 and 50 years) and the ending ages (69 and 74 years) in the four risk groups. Incremental cost-effectiveness and harm-benefit ratios were used to select the optimal strategies. Compared to risk-based strategies, the uniform ones result in a much lower benefit for a specific cost. Reductions close to 10% in costs and higher than 20% in false-positive results and overdiagnosed cases were obtained for risk-based strategies. Optimal screening is characterized by quinquennial or triennial periodicities for the low or moderate risk-groups and annual periodicity for the high-risk group. Risk-based strategies can reduce harm and costs. It is necessary to develop accurate measures of individual risk and to work on how to implement risk-based screening strategies.

Coldman AJ, Phillips N. Breast cancer survival and prognosis by screening history. Br J Cancer. 2014;110(3):556–9. Available from:
Interpretation: There was no evidence that cancers diagnosed within 12 months had poorer prognosis than those diagnosed up to 48 months following screening
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