Mammography or Improved Treatment: Which is More Strongly Associated with a Decline in Breast Cancer Mortality?
BACKGROUND AND PURPOSE:
Burton and Stevenson (JAMA Network Open, 2020) assessed the relative mortality reductions associated with mammography and adjuvant therapy among women with early breast cancer
Secondary analysis of cross-sectional studies
Victoria, Australia from January 1982 to December 2013
Invasive breast cancer
Population-based surveys of breast cancer treatment: From 1986 to 1999
Clinical information on breast cancer incidence, mortality, and TNM stage at diagnosis: From 1986 to 2013
Mammography data (BreastScreen Program): From 1992 to 2007
Participation in mammography screening program
Receipt of adjuvant therapy after surgery for EBC
Breast cancer incidence and mortality data were analyzed for all women with registered invasive breast cancer
Breast cancer treatment and screening data were analyzed additionally for the groups of surveyed women
Data were analyzed for
Associations between crude breast cancer mortality trends and uptake of adjuvant therapy
Downstaging by mammographic screening (lowering of stage)
Total of 76,630 women with breast cancer from January 1, 1982, to December 31, 2013
Increase in breast cancer mortality from 1982 to 1994
1982: 31.6 cases per 100,000 women
1999: 34.3 per 100,000 women in 1994
Significant declining trend in breast cancer mortality from 1994 to 2013
2013: 23.9 per 100,000 women
Annual percentage change −1.3% (95% CI, −1.6% to −0.9%)
By 1994, 74% of all women early breast cancer were receiving adjuvant endocrine therapy
Crude incidence of advanced-stage breast cancer almost doubled from 1986 to 2013
1986: 12.2 per 100,000 women
2013: 23.9 per 100,000 women
Mammography did not lead to downstaging of breast cancer from advanced to early
Benefit to population mortality is lacking
The decline in Victorian breast cancer mortality can be attributed to adjuvant therapy uptake and not mammography
The authors conclude that
We found that adjuvant therapy accounted for the observed 30% mortality decline; given this finding, we propose that BreastScreen should be terminated.
Continuous measurement of breast cancer stages at diagnosis, all-cause and breast cancer–specific mortality, and adjuvant therapy uptake should be mandatory in monitoring and evaluating mammographic screening program
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan