Breast cancer mortality in Copenhagen after the introduction of mammography screening
description
Transcript of Breast cancer mortality in Copenhagen after the introduction of mammography screening
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Breast cancer mortality in Copenhagen after the
introduction of mammography screening
Anne Helene OlsenDepartment of Epidemiology, University of Copenhagen
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Danish programmes Screening of women aged 50-69 every second year
Copenhagen 1991:40,000 women
Frederiksberg 1994:10,000 women
Fyn 1993:50,000 women
Programmes cover 20% of Danish women aged 50-69
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Objective
To estimate the effect of the Copenhagen mammography screening programme on breast cancer mortality
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Study and control groups
Copenhagen Rest of Denmark
Before screening
Screening period
Historical control group
Study group
Historical national control group
National control group
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Methods
Breast cancer mortality rates in the study group were compared with rates in the control
groups, adjusting for age, period and region.
Women were followed up from their first date of invitation to screening until death, emigration
or end of follow-up.
Refined mortality was used.
Poisson regression was used for the analyses.
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RR1:Region
RR2:Region* screening
Do regional differences in pre-screening period reflect those of the screening period?
If not: Screening effect confounded with region*period interaction
Screening effect estimated by RR2/RR1
Historical control group
Study group
Historical national control group
National control group
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Data sources
1. Mammography screening databases
2. Danish Cancer Register
3. Central Population Register
4. Cause of Death Register
Linkage by personal identification number
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Historical control group
Study group
Historical national control group
National control group
RR 1.22
RR 0.91
Results
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Estimated effect of participating in screening:
RR 0.63
Estimated effect of being offered screening: RR 0.75 (95% C.I. 0.63-0.89)
Results
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Since 1977: diagnostic and therapeutic strategies organised nationwide by Danish
Breast Cancer Cooperative Group
Regional differences time dependent?
Breast cancer patients in study and control groups have been offered the same
treatment
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Conclusion
It has been possible within the Copenhagen mammography screening
programme to reduce breast cancer mortality by an estimated 25% for
women offered screening and 37% for women participating in screening
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Reference
Olsen AH, Njor SH, Vejborg I, Schwartz W, Dalgaard P, Jensen M-B, Tange UB, Blichert-Toft M, Rank F, Mouridsen H, Lynge E.
Breast cancer mortality in Copenhagen after introduction of mammography screening: cohort study.
BMJ 2005; 330: 220-2.
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Financial support
1. Danish Medical Research Council
2. European Commission, DG Sanco
3. Danish Centre for Evaluation and Health Technology Assessment, Danish National Board of Health
4. Copenhagen Hospital Corporation