Absolute Numbers of Lives Saved and Overdiagnosis in Breast Cancer Screening, from a Randomized Trial and from the Breast Screening Programme in England

Overview

Journal J Med Screen

Specialty Public Health

Date 2010 Apr 2

PMID 20356942

Citations 67

Authors

Stephen W Duffy

Laszlo Tabar

Anne Helene Olsen

Bedrich Vitak

Prue C Allgood

Tony H H Chen

Amy M F Yen

Robert A Smith

Affiliations

Soon will be listed here.

Abstract

Objectives: To estimate the absolute numbers of breast cancer deaths prevented and the absolute numbers of tumours overdiagnosed in mammographic screening for breast cancer at ages 50-69 years.

Setting: The Swedish Two-County randomized trial of mammographic screening for breast cancer, and the UK Breast Screening Programme in England, ages 50-69 years.

Methods: We estimated the absolute numbers of deaths avoided and additional cases diagnosed in the study group (active study population) of the Swedish Two-County Trial, by comparison with the control group (passive study population). We estimated the same quantities for the mortality and incidence rates in England (1974-2004 and 1974-2003, respectively). We used Poisson regression for statistical inference.

Results: A substantial and significant reduction in breast cancer mortality was associated with screening in both the Two-County Trial (P < 0.001) and the screening programme in England (P < 0.001). The absolute benefits were estimated as 8.8 and 5.7 breast cancer deaths prevented per 1000 women screened for 20 years starting at age 50 from the Two-County Trial and screening programme in England, respectively. The corresponding estimated numbers of cases overdiagnosed per 1000 women screened for 20 years were, respectively, 4.3 and 2.3 per 1000.

Conclusions: The benefit of mammographic screening in terms of lives saved is greater in absolute terms than the harm in terms of overdiagnosis. Between 2 and 2.5 lives are saved for every overdiagnosed case.

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