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).

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.

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.