The impact of mammography screening programmes on incidence of advanced breast cancer in Europe: a literature review.

Background: Observational studies have reported conflicting results on the impact of mammography service screening programmes on the advanced breast cancer rate (ABCR), a correlation that was firmly established in randomized controlled trials. We reviewed and summarized studies of the effect of service screening programmes in the European Union on ABCR and discussed their limitations.

Methods: The PubMed database was searched for English language studies published between 01-01-2000 and 01-06-2018.

Mammographic density and breast cancer risk in breast screening assessment cases and women with a family history of breast cancer.

Background: Mammographic density has been shown to be a strong independent predictor of breast cancer and a causative factor in reducing the sensitivity of mammography. There remain questions as to the use of mammographic density information in the context of screening and risk management, and of the association with cancer in populations known to be at increased risk of breast cancer.

Aim: To assess the association of breast density with presence of cancer by measuring mammographic density visually as a percentage, and with two automated volumetric methods, Quantra™ and VolparaDensity™.

Effect of second timed appointments for non-attenders of breast cancer screening in England: a randomised controlled trial.

Background: In England, participation in breast cancer screening has been decreasing in the past 10 years, approaching the national minimum standard of 70%. Interventions aimed at improving participation need to be investigated and put into practice to stop this downward trend. We assessed the effect on participation of sending invitations for breast screening with a timed appointment to women who did not attend their first offered appointment within the NHS Breast Screening Programme (NHSBSP).

A randomised trial of the effect of postal reminders on attendance for breast screening.

Background: Some women make an informed choice not to attend breast screening, whereas others may have forgotten about the appointment. We report on a randomised trial that investigates whether a reminder letter affects attendance.

Methods: Women scheduled for a breast screening appointment were randomised to either receive a reminder letter a few days before their breast screening appointment in addition to the standard invitation letter (intervention) or not (control).

Translation of research results to simple estimates of the likely effect of a lung cancer screening programme in the United Kingdom.

Background: There is considerable interest in the possibility of provision of lung cancer screening services in many developed countries. There is, however, no consensus on the target population or optimal screening regimen.

Methods: In this paper, we demonstrate the use of published results on lung cancer screening and natural history parameters to estimate the likely effects of annual and biennial screening programmes in different risk populations, in terms of deaths prevented and of human costs, including screening episodes, further investigation rates and overdiagnosis.

Variation in colorectal cancer treatment and survival: a cohort study covering the East Anglia region.

Aim: National guidelines for colorectal cancer management aim to optimize cancer outcomes irrespective of postcode. However, in order to ensure equal performance of cancer services, variation in outcome must be monitored and intelligently assessed. In this study, detailed regional cancer registry data were used to quantify and explore the reasons for variation in colorectal cancer outcomes at nine hospitals in East Anglia.

Evaluation of mammographic surveillance services in women aged 40-49 years with a moderate family history of breast cancer: a single-arm cohort study.

Background: Women with a significant family history of breast cancer are often offered more intensive and earlier surveillance than is offered to the general population in the National Breast Screening Programme. Up to now, this strategy has not been fully evaluated.

Objective: To evaluate the benefit of mammographic surveillance for women aged 40-49 years at moderate risk of breast cancer due to family history.

Explaining the difference in prognosis between screen-detected and symptomatic breast cancers.

Background: We analysed 10-year survival data in 19,411 women aged 50-64 years diagnosed with invasive breast cancer in the West Midlands region of the United Kingdom. The aim was to estimate the survival advantage seen in cases that were screen detected compared with those diagnosed symptomatically and attribute this to shifts in prognostic variables or survival differences specific to prognostic categories.

Methods: We studied tumour size, histological grade and the Nottingham Prognostic Index in very narrow categories and investigated the distribution of these prognostic factors within screen-detected and symptomatic tumours.

Prognosis and pathology of screen-detected carcinomas: how different are they?

Background: It has been observed that screen-detected breast cancers have a better prognosis than symptomatic tumors, even after taking pathological tumor attributes into account. This has led to the hypothesis that screen-detected tumors are substantially biologically different from symptomatic cancers.

Methods: The pathology and survival by detection mode was investigated in 21,382 breast cancers diagnosed in women aged 50-64 years in the West Midlands, United Kingdom, between 1988 and 2004.

The impact of digital mammography on screening a young cohort of women for breast cancer in an urban specialist breast unit.

Objective: To compare the diagnostic performance of full-field digital mammography (FFDM) with screen-film mammography (SFM) in a corporate screening programme including younger women.

Methods: Data were available on 14,946 screening episodes, 5010 FFDM and 9936 SFM. Formal analysis was by logistic regression, adjusting for age and calendar year.

Absolute numbers of lives saved and overdiagnosis in breast cancer screening, from a randomized trial and from the Breast Screening Programme in England.

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).

Use of lung cancer risk models in planning research and service programs in CT screening for lung cancer.

Computed tomography screening for lung cancer is now being tested in a number of international trials. The long-term success of the approach in the future National Screening Programme is dependent upon identifying populations at sufficient risk of lung cancer that the benefit-harm ratio of the intervention is likely to be high. There are a number of lung cancer risk prediction models currently available.

Population estimates of survival in women with screen-detected and symptomatic breast cancer taking account of lead time and length bias.

Background: Evidence of the impact of breast screening is limited by biases inherent in non-randomised studies and often by lack of complete population data. We address this by estimating the effect of screen detection on cause-specific fatality in breast cancer, corrected for all potential biases, using population cancer registry data.

Methods: Subjects (N = 26,766) comprised all breast cancers notified to the West Midlands Cancer Intelligence Unit and diagnosed in women aged 50-74, from 1988 to 2004.

Correcting for lead time and length bias in estimating the effect of screen detection on cancer survival.

Determination of survival time among persons with screen-detected cancer is subject to lead time and length biases. The authors propose a simple correction for lead time, assuming an exponential distribution of the preclinical screen-detectable period. Assuming two latent categories of tumors, one of which is more prone to screen detection and correspondingly less prone to death from the cancer in question, the authors have developed a strategy of sensitivity analysis for various magnitudes of length bias.

Mammographic breast density by area of residence: possible evidence of higher density in urban areas.

Objectives: A comparison of mammographic breast densities of women living in London with those of women living in rural and suburban areas.

Design And Methods: Using the standard four American College of Radiology Breast Imaging Reporting and Data System (BIRADS) categories of mammographic density, 318 mammograms of women from London and 654 mammograms of women from outside the capital aged 27-87 years who had received mammography at the Princess Grace Hospital, London, were assessed for density. The association between having any dense tissue and area of residence was assessed using both ordered and standard logistic regression, giving odds ratio estimates of relative risk of dense tissue adjusting for age.

A case-control study of the impact of the East Anglian breast screening programme on breast cancer mortality.

Although breast cancer screening has been shown to work in randomised trials, there is a need to evaluate service screening programmes to ensure that they are delivering the benefit indicated by the trials. We carried out a case-control study to investigate the effect of mammography service screening, in the NHS breast screening programme, on breast cancer mortality in the East Anglian region of the UK. Cases were deaths from breast cancer in women diagnosed between the ages of 50 and 70 years, following the instigation of the East Anglia Breast Screening Programme in 1989.

Effects of specialisation on treatment and outcomes in screen-detected breast cancers in Wales: cohort study.

Volume-outcome relationships have been found for management of symptomatic but not for screen-detected, breast cancers. The study included 2705 patients with breast cancer detected by the Welsh breast cancer-screening programme from its inception in 1989 to 1997. Survival was tracked until 1999.

Audit of negative assessments in a breast-screening programme in women who later develop breast cancer-implications for survival.

The aim of this study was to examine observed short-term survival, to estimate future survival, and to assess the impact on survival of amending procedures to avoid false negatives in women recalled for further assessment due to a suspicious screening mammogram. From the start of screening in the seven centres in the East Anglian region, 1 April 1989 to 31 December 1999, 503493 women from a total population of 2.2 million were screened, 25346 were recalled for an assessment and 3689 were diagnosed with breast cancer.

An audit of assessment procedures in women who develop breast cancer after a negative result.

Objectives: A case audit was undertaken to determine the extent to which the early diagnosis of cancer could be improved by better adherence to screening guidelines, and to estimate the effect that this might have on breast cancer survival. Although affecting only a small proportion of the cancers of the screening programme, this exercise had an educational function for screening radiologists.

Setting: The East Anglian breast screening programme, a group of seven centres offering screening to a total population of 2.

Medical or surgical treatment for chronic gastrooesophageal reflux? A systematic review of published evidence of effectiveness.

Objective: To compare the effectiveness of medical (antacids, histamine antagonists and proton pump inhibitors) and surgical (fundoplication) treatment of chronic GORD.

Subjects: Patients with objective (endoscopic or pH) evidence of chronic reflux reported in 6 randomised trials and 3 cohort studies, 1966-1999.

Methods: Systematic review of comparative studies identified from electronic searches, citations, manual searches of journals, and correspondence with authors and experts.

Two populations of tyrosine hydroxylase-positive cells occur in the spinal cord of the chick embryo and hatchling.

The existence of tyrosine hydroxylase (TH)-containing neurons in the spinal cord of the chick embryo was investigated by anti-TH immunocytochemistry. Two populations of intensely immunostained cells were observed along the entire extent of the cord, beginning late in chick embryogenesis. One group of TH-positive cells was particularly numerous and found ventral to the central canal.

Analysis of the change in number of serotonergic neurons in the chick spinal cord during embryonic development.

The existence of serotonin (5-HT)-containing neurons in the spinal cord of the chick embryo was examined by anti-5-HT immunocytochemistry. The first immunoreactive cells were observed in embryos at 7 days of incubation (E7) and were initially located within the floor plate of the early spinal cord. By E9, immunostained cells occurred throughout the length of the spinal cord and were frequently encountered in most transverse sections of the cord.