BMJ  1988;297:943-948 (15 October), doi:10.1136/bmj.297.6654.943

Mammographic screening and mortality from breast cancer: the Malmö mammographic screening trial.

Department of Radiology, Malmö General Hospital, Sweden.

STUDY OBJECTIVE--To determine whether mortality from breast cancer could be reduced by repeated mammographic screening. DESIGN--Birth year cohorts of city population separately randomised into study and control groups. SETTING--Screening clinic outside main hospital. PATIENTS--Women aged over 45; 21,088 invited for screening and 21,195 in control group. INTERVENTIONS--Women in the study group were invited to attend for mammographic screening at intervals of 18-24 months. Five rounds of screening were completed. Breast cancer was treated according to stage at diagnosis. END POINT--Mortality from breast cancer. MEASUREMENTS AND MAIN RESULTS--All women were followed up and classed at end point as alive without breast cancer, alive with breast cancer, dead from breast cancer, or dead from other causes. Cause of death was taken from national mortality registry and for patients with breast cancer was validated independently. Mean follow up was 8.8 years. Altogether 588 cases of breast cancer were diagnosed in the study group and 447 in the control group; 99 v 94 women died of all causes and 63 v 66 women died of breast cancer (no significant difference; relative risk 0.96 (95% confidence interval 0.68 to 1.35)). In the study group 29% more women aged less than 55 died of breast cancer (28 v 22; relative risk 1.29 (0.74 to 2.25)). More women in the study group died from breast cancer in the first seven years; after that the trend reversed, especially in women aged greater than or equal to 55 at entry. Overall, women in the study group aged greater than or equal to 55 had a 20% reduction in mortality from breast cancer (35 v 44; relative risk 0.79 (0.51 to 1.24)). OTHER FINDINGS--In the study group 100 (17%) cancers appeared in intervals between screenings and 107 (18%) in non-attenders; 51 of these women died from breast cancer. Cancers classed as stages II-IV comprised 33% (190/579) of cancers in the study group and 52% (231/443) in the control group. CONCLUSIONS--Invitation to mammographic screening may lead to reduced mortality from breast cancer, at least in women aged 55 or over.

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• Welch, H G., Schwartz, L. M, Woloshin, S. (2006). Ramifications of screening for breast cancer: 1 in 4 cancers detected by mammography are pseudocancers.. BMJ 332: 727-727 [Full text]  
• Gotzsche, P. C (2006). Ramifications of screening for breast cancer: overdiagnosis in the Malmo trial was considerably underestimated.. BMJ 332: 727-727 [Full text]  
• Zackrisson, S., Andersson, I., Janzon, L., Manjer, J., Garne, J. P. (2006). Rate of over-diagnosis of breast cancer 15 years after end of Malmo mammographic screening trial: follow-up study. BMJ 332: 689-692 [Abstract] [Full text]  
• Mouchawar, J., Taplin, S., Ichikawa, L., Barlow, W. E., Geiger, A. M., Weinmann, S., Gilbert, J., Manos, M. M., Yood, M. U. (2005). Late-Stage Breast Cancer Among Women With Recent Negative Screening Mammography: Do Clinical Encounters Offer Opportunity for Earlier Detection?. J Natl Cancer Inst Monogr 2005: 39-46 [Abstract] [Full text]  
• Rhodes, D. J., O'Connor, M. K., Phillips, S. W., Smith, R. L., Collins, D. A. (2005). Molecular Breast Imaging: A New Technique Using Technetium Tc 99m Scintimammography to Detect Small Tumors of the Breast. Mayo Clin Proc. 80: 24-30 [Abstract]  
• Leonard, G. D., Swain, S. M. (2004). Ductal Carcinoma In Situ, Complexities and Challenges. JNCI J Natl Cancer Inst 96: 906-920 [Abstract] [Full text]  
• Gotzsche, P. C (2004). On the benefits and harms of screening for breast cancer. Int J Epidemiol 33: 56-64 [Full text]  
• Baines, C. J. (2003). Mammography Screening: Are Women Really Giving Informed Consent?. JNCI J Natl Cancer Inst 95: 1508-1511 [Full text]  
• Hackshaw, A. (2003). EUSOMA review of mammography screening. Ann Oncol 14: 1193-1195 [Abstract] [Full text]  
• Lee, S. J., Zelen, M. (2003). Modelling the early detection of breast cancer. Ann Oncol 14: 1199-1202 [Abstract] [Full text]  
• Boyle, P. (2003). Screening. Eur Respir J 21: 3S-15s [Abstract] [Full text]  
• Humphrey, L. L., Helfand, M., Chan, B. K.S., Woolf, S. H. (2002). Breast Cancer Screening: A Summary of the Evidence for the U.S. Preventive Services Task Force. ANN INTERN MED 137: 347-360 [Abstract] [Full text]  
• Black, W. C., Haggstrom, D. A., Gilbert Welch, H. (2002). All-Cause Mortality in Randomized Trials of Cancer Screening. JNCI J Natl Cancer Inst 94: 167-173 [Abstract] [Full text]  
• Petroc-Nustas, W. I. (2001). Factors Associated with Mammography Utilization among Jordanian Women. J Transcult Nurs 12: 284-291 [Abstract]  
• Barton, M. B., Harris, R., Fletcher, S. W. (1999). Does This Patient Have Breast Cancer?: The Screening Clinical Breast Examination: Should It Be Done? How?. JAMA 282: 1270-1280 [Abstract] [Full text]  
• Veit, C. T. (1999). Motivating Mammography Adherence in Elderly Latinas: A Test of Three Mathematical Models of Decision Making. Med Decis Making 19: 448-465 [Abstract]  
• Barratt, A., Irwig, L., Glasziou, P., Cumming, R. G., Raffle, A., Hicks, N., Gray, J. A. M., Guyatt, G. H., for the Evidence-Based Medicine Working Group, (1999). Users' Guides to the Medical Literature: XVII. How to Use Guidelines and Recommendations About Screening. JAMA 281: 2029-2034 [Full text]  
• Schweitzer, M. E., French, M. T., Ullmann, S. G., McCoy, C. B. (1998). Cost-Effectiveness of Detecting Breast Cancer in Lower Socioeconomic Status African American and Hispanic Women through Mobile Mammography Services. Med Care Res Rev 55: 99-115 [Abstract]  
• (1998). Bibliography. Current Sociology 46: 128-144  
• Myers, R. E., Murray, J., Weinberg, D., McGrory, G., Wolf, T., Caveny, J., Hanchak, N., Schlackman, N., Comis, R. (1997). Analysis of Colorectal Cancer Stage Among HMO Members Targeted for Screening. Arch Intern Med 157: 2001-2006 [Abstract]  
• Lindfors, K. K., Rosenquist, C. J. (1995). The Cost-effectiveness of Mammographic Screening Strategies. JAMA 274: 881-884 [Abstract]  
• Kattlove, H., Liberati, A., Keeler, E., Brook, R. H. (1995). Benefits and Costs of Screening and Treatment for Early Breast Cancer: Development of a Basic Benefit Package. JAMA 273: 142-148 [Abstract]  
• Kerlikowske, K., Grady, D., Rubin, S. M., Sandrock, C., Ernster, V. L. (1995). Efficacy of Screening Mammography: A Meta-analysis. JAMA 273: 149-154 [Abstract]  
• Kiefe, C. I., McKay, S. V., Halevy, A., Brody, B. A. (1994). Is Cost a Barrier to Screening Mammography for Low-Income Women Receiving Medicare Benefits? A Randomized Trial. Arch Intern Med 154: 1217-1224 [Abstract]  
• Solin, L. J., Legorreta, A., Schultz, D. J., Zatz, S., Goodman, R. L. (1994). The Importance of Mammographic Screening Relative to the Treatment of Women With Carcinoma of the Breast. Arch Intern Med 154: 745-752 [Abstract]  
• Kopans, D. B. (1994). The Use of Mammography for Screening. JAMA 271: 982-982 [Abstract]  
• Murphy, D. J., Povar, G. J., Pawlson, L. G. (1994). Setting Limits in Clinical Medicine. Arch Intern Med 154: 505-512 [Abstract]  
• Kerlikowske, K., Grady, D., Barclay, J., Sickles, E. A., Eaton, A., Ernster, V. (1993). Positive Predictive Value of Screening Mammography by Age and Family History of Breast Cancer. JAMA 270: 2444-2450 [Abstract]  
• Slawson, D. C. (1993). Informed Medical Decisions. Arch Fam Med 2: 813-813 [Abstract]  
• Fletcher, S. W., Fletcher, R. H. (1992). The Breast Is Close to the Heart. ANN INTERN MED 117: 969-971 [Abstract]  
• Richert-Boe, K. E., Humphrey, L. L. (1992). Screening for Cancers of the Cervix and Breast. Arch Intern Med 152: 2405-2411 [Abstract]  
• Nattinger, A. B., Goodwin, J. S. (1992). Screening Mammography for Older Women: A Case of Mixed Messages. Arch Intern Med 152: 922-925 [Abstract]  
• Mandelblatt, J. S., Wheat, M. E., Monane, M., Moshief, R. D., Hollenberg, J. P., Tang, J. (1992). Breast Cancer Screening for Elderly Women with and without Comorbid Conditions: A Decision Analysis Model. ANN INTERN MED 116: 722-730 [Abstract]  
• Love, R. R., Davis, J. E. (1991). Screening Mammography in Clinical Practice: A Complex Activity. Arch Intern Med 151: 19-21 [Abstract]  
• Colditz, G. A., Stampfer, M. J., Willett, W. C., Hennekens, C. H., Rosner, B., Speizer, F. E. (1990). Prospective Study of Estrogen Replacement Therapy and Risk of Breast Cancer in Postmenopausal Women. JAMA 264: 2648-2653 [Abstract]  
• Eddy, D. M. (1990). Anatomy of a Decision. JAMA 263: 441-443 [Abstract]  
• Council on Scientific Affairs, (1989). Mammographic Screening in Asymptomatic Women Aged 40 Years and Older. JAMA 261: 2535-2542 [Abstract]  

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