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| 54. |
- Jonsson, Håkan, et al.
(författare)
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Age-specific differences in tumour characteristics between screen-detected and non-screen-detected breast cancers in women aged 40–74 at diagnosis in Sweden from 2008 to 2017
- 2024
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Ingår i: Journal of Medical Screening. - : Sage Publications. - 0969-1413 .- 1475-5793.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To analyze differences between screen-detected and non-screen-detected invasive breast cancers by tumour characteristics and age at diagnosis in the nationwide population-based mammography screening program in Sweden.Methods: Data were retrieved from the National Quality Register for Breast Cancer for 2008-2017. Logistic regression analysis was used to estimate the likelihood for a tumour to be screen-detected by tumour characteristics and age group at diagnosis.Results: In total there were 51,429 invasive breast cancers in the target age group for mammography screening of 40-74 years. Likelihood of screen detection decreased with larger tumour size, lymph node metastases, higher histological grade and distant metastasis. Odds ratios (ORs) for negative oestrogen (ER) and progesterone (PgR) were 0.41 and 0.57; for positive HER2, 0.62; for Ki-67 high versus low, 0.49. Molecular sub-types had OR of 0.56, 0.40 and 0.28, respectively, for luminal B-like, HER2-positive and triple negative versus luminal A-like. Adjusting for tumour size (T), lymph node status (N), age, year and county at diagnosis slightly elevated the ORs. Statistically significant interactions between tumour characteristics and age were found (p < 0.05) except for ER and PgR. The age group 40-49 deviated most from the other age groups.Conclusions: Our study demonstrates that screen-detected invasive breast cancers had more favourable tumour characteristics than non-screen-detected after adjusting for age, year and county of diagnosis, and even after adjusting for T and N. The trend towards favourable tumour characteristics was less pronounced in the 40-49 age group compared to the other age groups, except for ER and PgR.
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| 55. |
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| 56. |
- Jonsson, Håkan, et al.
(författare)
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Service screening with mammography in Northern Sweden : effects on breast cancer mortality - an update.
- 2007
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Ingår i: Journal of Medical Screening. - : SAGE Publications. - 0969-1413 .- 1475-5793. ; 14:2, s. 87-93
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study the effectiveness of service screening with mammography in Northern Sweden. SETTING: Two counties which invited women aged 40-74 years to service screening with mammography were compared with two counties where service screening started 5-7 years later. There were 109,000 and 77,000 women in the study and control counties, respectively. METHODS: Cohorts in the study group were defined to include only breast cancer cases diagnosed after their first invitation to screening. Two outcome measures for breast cancer mortality were used; excess mortality and underlying cause of death (UCD). Detection mode was used to estimate the efficacy of screening for those women who actually attended screening. The cohorts were followed for 11 years. RESULTS: The relative rate (RR) of breast cancer death as excess mortality and UCD for women aged 40-74 years invited to screening, compared with women not yet invited, was 0.70 (95% confidence interval [CI] 0.56-0.87) and 0.74 (95% CI 0.62-0.88), respectively. The largest effect was seen in women aged 40-49 years (RR = 0.64 and RR = 0.62 for excess mortality and UCD, respectively). RR in age 40-74 years for women actually screened was 0.65 (95% CI 0.51-0.84) and 0.70 (95% CI 0.57-0.86) for excess mortality and UCD, respectively. The number of women needed to screen to save one life was 912 after 11 years of follow-up. CONCLUSIONS: This study confirms previous findings in the earlier follow-up and indicates a long-term reduction of breast cancer mortality by 26-30%. The efficacy among those who actually attended screening was about 5% larger.
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| 57. |
- Jonsson, Håkan, 1956-, et al.
(författare)
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Service Screening with Mammography in Sweden : Evaluation of Effects of Screening on Breast Cancer Mortality in Age Group 40–49 Years
- 2000
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Ingår i: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 39:5, s. 617-623
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to develop a model for estimating the effect of the nation-wide service screening program with mammography on breast cancer mortality in Sweden. In 1997, the introduction of population-based service screening had been completed in all 26 counties. In approximately half of the counties suitable for evaluation, the lower age limit for invitation was 40 years (study population) and in the other half the age limit was 50 years (control population). The numbers of females aged 40-49 years for the two populations were 202 152 and 237 279, respectively (1988). The study and control populations were compared for the period 1986-1996 with regard to refined breast cancer mortality. To adjust for geographical differences, the period 1976-1986 was used as reference. With a mean follow-up time of 8 years, the estimated relative risk of breast cancer death in relation to invitation to service screening among women aged 40-49 years at breast cancer diagnosis was 0.91 (95% confidence interval 0.72-1.15). These findings were compatible with those presented in the previous overview of the Swedish randomized studies.
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| 58. |
- Jonsson, Håkan, 1956-, et al.
(författare)
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Service screening with mammography of women aged 50–69 years in Sweden : effects on mortality from breast cancer
- 2001
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Ingår i: Journal of Medical Screening. - : Sage Publications. - 0969-1413 .- 1475-5793. ; 8:3, s. 152-160
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:To estimate the effect of the population based service screening programme in Sweden on mortality from breast cancer among women aged 50–69. SETTING:In 1986, population based service screening with mammography started in Sweden, and by 1997 screening had been introduced in all counties. Half of the counties invite women from 40 years of age whereas women 50 and older are invited in the other counties. The upper age limit was either 69 or 74. Women in the age group 50–69 years are thus invited to screening in all counties.METHODS:The counties which started with mammographic screening in 1986–87 constituted the study group and were compared with the counties which started in 1993 or later. In 1987 the mean number of women aged 50–69 was 161 986 and 98 608 in the study and control groups, respectively. Refined excess mortality (smoothed with the Lowess method) from breast cancer and refined cause specific mortality from breast cancer were used as effect measures. To adjust for geographical differences in mortality from breast cancer a reference period was used. Allowance was made for two potential biases: (a) inclusion bias implying the inclusion of cases diagnosed before invitation to screening in the first screening round, and (b) lead time bias.RESULTS:After a mean follow up time of 10.6 years since the start of screening and a mean individual follow up time of 8.4 years, a non-significant reduction in refined excess mortality for breast cancer was estimated as relative risk (RR) 0.84 (95% confidence interval (95% CI) 0.67 to 1.05). After adjustment for inclusion and lead time biases the RR was 0.80 (20% reduction). Only 27% of the deaths from breast cancer in the total mortality for women aged 50–79 at death consisted of women aged 50–69 at diagnosis who were diagnosed after the start of screening. This figure has important implications for judgement of the impact of screening on age specific national breast cancer mortalities.CONCLUSIONS:A non-significant reduction in mortality from breast cancer was found in counties performing service screening with mammography in Sweden. Adjustment for possible biases changed the result towards a larger effect of screening. The results do not contradict the effects found in the Swedish randomised mammography trials.
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| 59. |
- Jonsson, Håkan, 1956-, et al.
(författare)
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Service screening with mammography of women aged 70-74 years in Sweden : effects on breast cancer mortality
- 2003
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Ingår i: Cancer Detection and Prevention. - 0361-090X .- 1873-443X. ; 27:3, s. 360-369
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Tidskriftsartikel (refereegranskat)abstract
- Since the benefit of mammography screening for women 70 years and older is unclear, the aim of the present study was to evaluate the effect on breast cancer mortality of the population-based service-screening program in Sweden inviting women 70-74 years. Among the counties with service-screening programs in Sweden which started 1986-1990 those with upper age limit 74 years were compared to counties with 69 years as upper age limit with respect to refined breast cancer mortality. Allowance was made for potential biases namely inclusion of cases diagnosed before invitation and lead time. Two methods for estimation of breast cancer mortality were used; underlying cause of death (UCD) and excess mortality. With a mean follow-up of 10.1 years a reduction of the breast cancer excess mortality was estimated at 24%. Using the underlying cause of death the corresponding result was 6%. A non-significant reduction in breast cancer mortality was found in the counties with service-screening program including the age group 70-74 years in Sweden. The estimated reduction was larger when using excess mortality compared to the use of individual underlying cause of death.
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| 60. |
- Kemetli, Levent, et al.
(författare)
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Temporal trends in the use of adjuvant systemic therapy in breast cancer : a population based study in Sweden 1976-2005.
- 2009
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 48:1, s. 59-66
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Both adjuvant therapy and mammography screening can decrease breast cancer mortality and there is a need of knowing to what extent those two modalities are used in the population. Screening coverage is well documented but there is a scarcity of population-based data on use of systemic adjuvant treatment. AIM: To describe the introduction, and trends in the use of adjuvant systemic therapy for breast cancer in two of six public health regions in Sweden. MATERIAL & METHODS: Population-based data on use of adjuvant therapy were available from databases with documented high quality and high coverage data for Stockholm (1976-2005) and North Sweden (1980-2003, and 2005). RESULTS: The use of systemic treatment was infrequent before the late 1980s in both regions, but increased during the 1990s. In 2005, the proportion of operable breast cancer patients treated with adjuvant endocrine therapy in the ages 40-59 was around 60 to 80%. The proportion adjuvant chemotherapy was less than 15% for the ages 70-74. For the north region the use of endocrine therapy increased successively over time, with an exception for age group 40-49 were a more rapidly increase occurred in the late 1990s. In Stockholm the increment was higher and more rapidly. There was no clear difference in chemotherapy use between the regions, and the use increased from the mid 1980s in age group 40-49, and in the early 1990s for women aged 50-59. In age group's 60-69 and 70-74 the use was relatively infrequent. CONCLUSIONS: Trends in, and levels of the use of adjuvant systemic therapy for breast cancer varied over time in the two study regions, particularly for endocrine therapy. We consider that the differences between the regions mainly reflect different interpretations of new scientific evidence. We stress the importance of a good documentation of all new treatment protocols.
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