Gauging the impact of breast carcinoma screening in terms of tumor size and death rate

Authors

  • James S. Michaelson Ph.D.,

    Corresponding author
    1. Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
    2. Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
    3. Department of Pathology, Harvard Medical School, Boston, Massachusetts
    • Division of Surgical Oncology, Cox Building Room 626, Massachusetts General Hospital, 100 Blossom Street, Boston, MA 02114
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    • Fax: (508) 457-0763

  • Sameer Satija,

    1. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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  • Daniel Kopans M.D.,

    1. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
    2. Department of Radiology, Harvard Medical School, Boston, Massachusetts
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  • Richard Moore,

    1. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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  • Melvin Silverstein M.D.,

    1. The Harold E. and Henrietta C. Lee Breast Center, University of Southern California/Norris Cancer Center, University of Southern California, Los Angeles California
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  • Arthur Comegno M.A.,

    1. Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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  • Kevin Hughes M.D.,

    1. Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
    2. Department of Surgery, Harvard Medical School, Boston, Massachusetts
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  • Alphonse Taghian M.D.,

    1. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
    2. Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
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  • Simon Powell M.D., Ph.D.,

    1. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
    2. Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
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  • Barbara Smith M.D., Ph.D.

    1. Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
    2. Department of Surgery, Harvard Medical School, Boston, Massachusetts
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Abstract

BACKGROUND

While the question of whether the trials of breast cancer screening have resulted in a reduction in breast cancer death has been the subject of much scrutiny, there has been less attention to the reduction in tumor size achieved by screening.

METHODS

Size data for invasive breast tumors were assembled from a variety of sources. The health consequences that can be expected from finding tumors of various sizes were determined using a recently developed mathematical method for relating tumor size to death rate.

RESULTS

First, in both the Swedish two-country trial and at the MGH Breast Imaging Division, the sizes of the invasive breast cancers in the screening population (those masses seen at screening together with those found as palpable masses after screening examinations) were sufficiently smaller than the cancers found among women who had not used screening to have lead to considerable reductions in death. Second, the lack of reduction in death rates detected in both Canadian National Breast Screening Studies could be ascribed to the small reductions in tumor size achieved in these studies. Third, radiographic density had a small effect, whereas age had a negligible effect, on the capacity of mammographic screening to find breast carcinomas at smaller, and thus less lethal, sizes.

CONCLUSIONS

Prompt attendance at annual mammographic screening offers the potential to reduce tumor size and, presumably, breast carcinoma death, in women of all ages and density groups. Cancer 2003. © 2003 American Cancer Society.

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