Effect of Screening and Adjuvant Therapy on Mortality from Breast Cancer
Donald A. Berry, Ph.D., Kathleen A. Cronin, Ph.D., Sylvia K. Plevritis, Ph.D., Dennis G. Fryback, Ph.D., Lauren Clarke, M.S., Marvin Zelen, Ph.D., Jeanne S. Mandelblatt, Ph.D., Andrei Y. Yakovlev, Ph.D., J. Dik F. Habbema, Ph.D., Eric J. Feuer, Ph.D., for the Cancer Intervention and Surveillance Modeling Network (CISNET) Collaborators
Background We used modeling techniques to assess the relativeand absolute contributions of screening mammography and adjuvanttreatment to the reduction in breast-cancer mortality in theUnited States from 1975 to 2000.
Methods A consortium of investigators developed seven independentstatistical models of breast-cancer incidence and mortality.All seven groups used the same sources to obtain data on theuse of screening mammography, adjuvant treatment, and benefitsof treatment with respect to the rate of death from breast cancer.
Results The proportion of the total reduction in the rate ofdeath from breast cancer attributed to screening varied in theseven models from 28 to 65 percent (median, 46 percent), withadjuvant treatment contributing the rest. The variability acrossmodels in the absolute contribution of screening was largerthan it was for treatment, reflecting the greater uncertaintyassociated with estimating the benefit of screening.
Conclusions Seven statistical models showed that both screeningmammography and treatment have helped reduce the rate of deathfrom breast cancer in the United States.
Source Information
From M.D. Anderson Cancer Center, Houston (D.A.B.); the National Cancer Institute, Bethesda, Md. (K.A.C., E.J.F.); Stanford University, Stanford, Calif. (S.K.P.); the University of Wisconsin–Madison, Madison (D.G.F.); Cornerstone Systems, Lynden, Wash. (L.C.); Dana–Farber Cancer Institute, Boston (M.Z.); Georgetown University, Washington, D.C. (J.S.M.); the University of Rochester, Rochester, N.Y. (A.Y.Y.); and Erasmus University Medical Center, Rotterdam, the Netherlands (J.D.F.H.).
Address reprint requests to Dr. Berry at the Department of Biostatistics and Applied Mathematics, M.D. Anderson Cancer Center, Unit 447, 1515 Holcombe Blvd., Houston, TX 77030, or at dberry{at}mdanderson.org.
Screening and Breast Cancer
Baker S. G., Gøtzsche P. C., Baglioni P., Smith D. W., Retsky M. W., Demicheli R., Hrushesky W. J.M., Berry D. A., Plevritis S. K., Fryback D. G.
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N Engl J Med 2006;
354:767-769, Feb 16, 2006.
Correspondence
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