BMJ  2004;328:921-924 (17 April), doi:10.1136/bmj.38044.666157.63 (published 10 March 2004)

Paper

Incidence of breast cancer in Norway and Sweden during introduction of nationwide screening: prospective cohort study

Per-Henrik Zahl, senior statistician1, Bjørn Heine Strand, statistician1, Jan Mæhlen, professor2

1 Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403 Oslo, Norway, 2 Department of Pathology, Ullevål University Hospital, N-0407 Oslo, Norway

Correspondence to: J Mæhlen jan.mahlen{at}ioks.uio.no

Objective To determine whether any increase in the incidence of breast cancer in women detected by mammography is compensated for by a drop in the incidence after age 69, years when women are no longer invited for screening.

Design Population based cohort study of incidence of breast cancer during the introduction of nationwide screening programmes.

Setting Norway and Sweden.

Participants All women aged above 30 years (1.4 and 2.9 million, respectively, in 2000).

Main outcome measures Changes in age specific incidence rates of invasive breast cancer associated with the introduction of the screening programmes.

Results As a result of screening the recorded incidence of breast cancer in women aged 50-69 years increased by 54% in Norway and 45% in Sweden. There was no corresponding decline in incidence after the age of 69 years.

Conclusions Without screening one third of all invasive breast cancers in the age group 50-69 years would not have been detected in the patients' lifetime. This level of overdiagnosis is larger than previously reported.


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Articles

Overdiagnosis and mammography screening
H Gilbert Welch
BMJ 2009 339: b1425. [Extract] [Full Text]

Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends
Karsten Juhl Jørgensen and Peter C Gøtzsche
BMJ 2009 339: b2587. [Abstract] [Full Text] [PDF]

Breast screening: the facts—or maybe not
Peter C Gøtzsche, Ole J Hartling, Margrethe Nielsen, John Brodersen, and Karsten Juhl Jørgensen
BMJ 2009 338: b86. [Extract] [Full Text]

Evaluating new screening tests for breast cancer
Les Irwig, Nehmat Houssami, Bruce Armstrong, and Paul Glasziou
BMJ 2006 332: 678-679. [Extract] [Full Text] [PDF]

Ramifications of screening for breast cancer: Definition of overdiagnosis is confusing in follow-up of Malmö trial
Per-Henrik Zahl and Jan Mæhlen
BMJ 2006 332: 727-728. [Extract] [Full Text]

Rate of over-diagnosis of breast cancer 15 years after end of Malmö mammographic screening trial: follow-up study
Sophia Zackrisson, Ingvar Andersson, Lars Janzon, Jonas Manjer, and Jens Peter Garne
BMJ 2006 332: 689-692. [Abstract] [Full Text] [PDF]

Content of invitations for publicly funded screening mammography
Karsten Juhl Jørgensen and Peter C Gøtzsche
BMJ 2006 332: 538-541. [Full Text] [PDF]

Skin biopsy rates and incidence of melanoma: population based ecological study
H Gilbert Welch, Steven Woloshin, and Lisa M Schwartz
BMJ 2005 331: 481. [Abstract] [Full Text] [PDF]

Reduction in mortality from breast cancer: Presentation of benefits and harms needs to be balanced
Peter C Gøtzsche, Hazel Thornton, and Karsten J Jørgensen
BMJ 2005 330: 1024. [Extract] [Full Text]

Model of outcomes of screening mammography: information to support informed choices
Alexandra Barratt, Kirsten Howard, Les Irwig, Glenn Salkeld, and Nehmat Houssami
BMJ 2005 330: 936. [Abstract] [Full Text] [PDF]

Overdiagnosis of breast cancer may be higher than previously thought
BMJ 2004 328: 0. [Full Text]

This article has been cited by other articles:

  • Nelson, H. D., Tyne, K., Naik, A., Bougatsos, C., Chan, B. K., Humphrey, L. (2009). Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force. ANN INTERN MED 151: 727-737 [Abstract] [Full text]  
  • Welch, H. G., Albertsen, P. C. (2009). Prostate Cancer Diagnosis and Treatment After the Introduction of Prostate-Specific Antigen Screening: 1986-2005. JNCI J Natl Cancer Inst 101: 1325-1329 [Abstract] [Full text]  
  • Coupland, V. H., Okello, C., Davies, E. A., Bray, F., Moller, H. (2009). The future burden of cancer in London compared with England. J Public Health (Oxf) 0: fdp082v1-fdp082 [Abstract] [Full text]  
  • Welch, H G. (2009). Overdiagnosis and mammography screening. BMJ 339: b1425-b1425 [Full text]  
  • Jorgensen, K. J., Gotzsche, P. C (2009). Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends. BMJ 339: b2587-b2587 [Abstract] [Full text]  
  • Gotzsche, P. C, Hartling, O. J, Nielsen, M., Brodersen, J., Jorgensen, K. J. (2009). Breast screening: the facts--or maybe not. BMJ 338: b86-b86 [Full text]  
  • Zahl, P.-H., Maehlen, J., Welch, H. G. (2008). The Natural History of Invasive Breast Cancers Detected by Screening Mammography. Arch Intern Med 168: 2311-2316 [Abstract] [Full text]  
  • Sihto, H., Lundin, J., Lehtimaki, T., Sarlomo-Rikala, M., Butzow, R., Holli, K., Sailas, L., Kataja, V., Lundin, M., Turpeenniemi-Hujanen, T., Isola, J., Heikkila, P., Joensuu, H. (2008). Molecular Subtypes of Breast Cancers Detected in Mammography Screening and Outside of Screening. Clin. Cancer Res. 14: 4103-4110 [Abstract] [Full text]  
  • Welch, H. G., Woloshin, S., Schwartz, L. M. (2008). The Sea of Uncertainty Surrounding Ductal Carcinoma In Situ--The Price of Screening Mammography. JNCI J Natl Cancer Inst 100: 228-229 [Full text]  
  • Welch, H. G., Woloshin, S., Schwartz, L. M., Gordis, L., Gotzsche, P. C., Harris, R., Kramer, B. S., Ransohoff, D. F. (2007). Overstating the Evidence for Lung Cancer Screening: The International Early Lung Cancer Action Program (I-ELCAP) Study. Arch Intern Med 167: 2289-2295 [Abstract] [Full text]  
  • Waller, M., Moss, S., Watson, J., Moller, H. (2007). The Effect of Mammographic Screening and Hormone Replacement Therapy Use on Breast Cancer Incidence in England and Wales. Cancer Epidemiol. Biomarkers Prev. 16: 2257-2261 [Abstract] [Full text]  
  • Bluming, A. Z., Elfenbein, G. J., Kliewer, E. V., Demers, A. A., Nugent, Z. J., Zahl, P.-H., Maehlen, J., Cady, B., Chung, M. A., Michaelson, J. S., Robbins, A. S., Clarke, C. A., Signorello, L. B., Tarone, R. E., Ravdin, P. M., Cronin, K. A., Chlebowski, R. T. (2007). A Decline in Breast-Cancer Incidence. NEJM 357: 509-513 [Full text]  
  • Stout, N. K., Rosenberg, M. A., Trentham-Dietz, A., Smith, M. A., Robinson, S. M., Fryback, D. G. (2006). Retrospective cost-effectiveness analysis of screening mammography.. JNCI J Natl Cancer Inst 98: 774-782 [Abstract] [Full text]  
  • Irwig, L., Houssami, N., Armstrong, B., Glasziou, P. (2006). Evaluating new screening tests for breast cancer.. BMJ 332: 678-679 [Full text]  
  • Zahl, P.-H., Maehlen, J. (2006). Ramifications of screening for breast cancer: definition of overdiagnosis is confusing in follow-up of Malmo trial.. BMJ 332: 727-728 [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]  
  • Jorgensen, K. J., Gotzsche, P. C (2006). Content of invitations for publicly funded screening mammography.. BMJ 332: 538-541 [Full text]  
  • Braaten, T., Weiderpass, E., Kumle, M., Lund, E. (2005). Explaining the Socioeconomic Variation in Cancer Risk in the Norwegian Women and Cancer Study. Cancer Epidemiol. Biomarkers Prev. 14: 2591-2597 [Abstract] [Full text]  
  • Maffini, M. V., Calabro, J. M., Soto, A. M., Sonnenschein, C. (2005). Stromal Regulation of Neoplastic Development: Age-Dependent Normalization of Neoplastic Mammary Cells by Mammary Stroma. Am. J. Pathol. 167: 1405-1410 [Abstract] [Full text]  
  • Welch, H G., Woloshin, S., Schwartz, L. M (2005). Skin biopsy rates and incidence of melanoma: population based ecological study. BMJ 331: 481- [Abstract] [Full text]  
  • Muir, M. (2005). Hygieia. J. Epidemiol. Community Health 59: 712-712 [Full text]  
  • Bakken, K., Lund, E., Eggen, A. E. (2005). The Impact of Hormone Replacement Therapy on the Incidence of Breast Cancer in Norway. JCO 23: 3636-3637 [Full text]  
  • Gotzsche, P. C, Thornton, H., Jorgensen, K. J (2005). Reduction in mortality from breast cancer: Presentation of benefits and harms needs to be balanced. BMJ 330: 1024-1024 [Full text]  
  • Barratt, A., Howard, K., Irwig, L., Salkeld, G., Houssami, N. (2005). Model of outcomes of screening mammography: information to support informed choices. BMJ 330: 936- [Abstract] [Full text]  
  • Elmore, J. G., Armstrong, K., Lehman, C. D., Fletcher, S. W. (2005). Screening for Breast Cancer. JAMA 293: 1245-1256 [Abstract] [Full text]  
  • Brawley, O. W., Kramer, B. S. (2005). Cancer Screening in Theory and in Practice. JCO 23: 293-300 [Abstract] [Full text]  
  • McCaffery, K. J, Barratt, A. L (2004). Assessing psychosocial/quality of life outcomes in screening: how do we do it better?. J. Epidemiol. Community Health 58: 968-970 [Full text]  
  • Zahl, P.-H., Andersen, J. M., Maehlen, J. (2004). Spontaneous Regression of Cancerous Tumors Detected by Mammography Screening. JAMA 292: 2579-2580 [Full text]  
  • Joensuu, H., Lundin, J. (2004). Spontaneous Regression of Cancerous Tumors Detected by Mammography Screening--Reply. JAMA 292: 2580-2580 [Full text]  
  • Hemminki, K., Rawal, R., Bermejo, J. L. (2004). Mammographic Screening Is Dramatically Changing Age-Incidence Data for Breast Cancer. JCO 22: 4652-4653 [Full text]  
  • Baum, M. (2004). Breast Cancer Screening Comes Full Circle. JNCI J Natl Cancer Inst 96: 1490-1491 [Full text]  
  • Joensuu, H., Lehtimaki, T., Holli, K., Elomaa, L., Turpeenniemi-Hujanen, T., Kataja, V., Anttila, A., Lundin, M., Isola, J., Lundin, J. (2004). Risk for Distant Recurrence of Breast Cancer Detected by Mammography Screening or Other Methods. JAMA 292: 1064-1073 [Abstract] [Full text]  
  • Barratt, A., Trevena, L., Davey, H. M, McCaffery, K. (2004). Use of decision aids to support informed choices about screening. BMJ 329: 507-510 [Full text]  
  • Potter, J. D. (2004). Toward the Last Cohort. Cancer Epidemiol. Biomarkers Prev. 13: 895-897 [Full text]  

Rapid Responses:

Read all Rapid Responses

Unjustified conclusion on overdiagnosis
Bjørn Møller, et al.
bmj.com, 17 Mar 2004 [Full text]
Overdiagnosis in mammography screening.
Sisse H. Njor, et al.
bmj.com, 26 Mar 2004 [Full text]
Overdiagnosis in breast cancer screening
Matti Hakama, et al.
bmj.com, 1 Apr 2004 [Full text]
Increases in breast cancer incidence
Ellen C G Grant
bmj.com, 2 Apr 2004 [Full text]
MAMMOGRAPHIC SCREENING AND THE INCIDENCE OF BREAST CANCER
Kari Hemminki, et al.
bmj.com, 2 Apr 2004 [Full text]
Rapid Responses; Authors' reply.
Jan Mæhlen, et al.
bmj.com, 5 Apr 2004 [Full text]
Re: Rapid Responses; Authors' reply.
Ellen C G Grant
bmj.com, 8 Apr 2004 [Full text]
Spontaneous regression and over diagnosis of cancer detected by screening
R. Tim D. Oliver
bmj.com, 20 Apr 2004 [Full text]
Yet more evidence of overdiagnosis: will it be used?
Hazel Thornton
bmj.com, 24 Apr 2004 [Full text]
Re: Rapid responses; Author's reply
Sisse H. Njor, et al.
bmj.com, 26 Apr 2004 [Full text]
Redefinition of invasive breast cancer?
Vilhjalmur Rafnsson
bmj.com, 29 Apr 2004 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ