Uptake of screening and prevention in women at very high risk of breast cancer. Management of women at high lifetime risk of familial breast cancer is hampered because of limited data concerning the appropriateness of treatment options. Over the past 8 years women at very high (>40%) lifetime risk of breast cancer have had the option of entering two chemoprevention treatment trials, a magnetic resonance imaging (MRI) breast screening study, or a risk-reducing mastectomy (RRM) study. Only 10 (...) % of eligible women have entered one of the chemotherapy trials with a similar proportion opting for RRM (>50% in mutation carriers) compared with 60% opting for MRI screening. Future chemotherapy trials will have to be designed to address this poor recruitment.

Screening for breast cancer with mammography. Mammographic screening for breast cancer is controversial, as reflected in greatly varying national policies.To assess the effect of screening for breast cancer with mammography on mortality and morbidity.MEDLINE (16 May 2000), The Cochrane Breast Cancer Group's trial register (24 Jan 2000) and reference lists. Letters, abstracts and unpublished trials. Authors were contacted.Randomised trials comparing mammographic screening with no mammographic (...) in favour of screening. Flaws are due to differential exclusion of women with breast cancer from analysis and differential misclassification of cause of death.The currently available reliable evidence does not show a survival benefit of mass screening for breast cancer (and the evidence is inconclusive for breast cancer mortality). Women, clinicians and policy makers should consider these findings carefully when they decide whether or not to attend or support screening programs.

Strategies for increasing women participation in community breast cancer screening. Strategies for reducing breast cancer mortality in western countries have focused on screening, at least for women aged 50 to 69 years. One of the requirements of any community screening program is to achieve a high participation rate, which is related to methods of invitation. Therefore, it was decided to systematically review the scientific evidence on the different strategies aimed at improving women's (...) participation in breast cancer screening programs and activities.To assess the effectiveness of different strategies for increasing the participation rate of women invited to community (population-based) breast cancer screening activities or mammography programs.MEDLINE (1966-2000), CENTRAL (2000), and EMBASE (1998-1999) searches for 1966 to 1999 were supplemented by reports and letters to the European Screening Breast Cancer Programs (Euref Network).Both published and unpublished trials were eligible

, or invasive breast cancer and ductal carcinoma in situ. All the studies related to cancers occurring within one year of screening, except for one study that covered a 2-year period. Participants included in the review The women included in the review were users and non-users of HRT who had received mammographic screening. Non-users of HRT included women who had never used HRT, as well as previous users of HRT. Outcomes assessed in the review Studies reporting the risk of interval breast cancer or risk (...) for confounding factors, investigate the effect of duration, dose and type of HRT, as well as how recently it was used. Methods offering improved detection of breast cancer in women currently using HRT need to be developed. Bibliographic details Banks E. Hormone replacement therapy and the sensitivity and specificity of breast cancer screening: a review. Journal of Medical Screening 2001; 8(1): 29-35 PubMedID Indexing Status Subject indexing assigned by NLM MeSH Aged; Breast Neoplasms /diagnosis /epidemiology

Preventive health care, 2001 update: screening mammography among women aged 40 - 49 years at average risk of breast cancer Preventive health care, 2001 update: screening mammography among women aged 40 - 49 years at average risk of breast cancer Preventive health care, 2001 update: screening mammography among women aged 40 - 49 years at average risk of breast cancer Ringash J, Canadian Task Force on Preventive Health Care Authors' objectives To consider the new and updated evidence available (...) , since a review in 1994, about the effect of screening mammography on breast cancer mortality among women aged 40 to 49 years. Searching MEDLINE and Cancerlit were searched from 1966 to June 2000; the search terms were reported. Reference lists were checked for additional studies. Study selection Study designs of evaluations included in the review Randomised controlled trials (RCTs), or meta-analyses including all eligible RCTs, were eligible for inclusion in the section on the effectiveness

Effectiveness and cost-effectiveness of double reading of mammograms in breast cancer screening: findings of a systematic review Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.

and environmental stresses to women in the western world. There may also be a different level of acceptance for breast self-examination techniques (and women touching their own bodies) in different cultures. These large studies are not necessarily representative of western women. 3. Breast cancer mortality, rather than disease identification, was the primary outcome in this review. It may be more worthwhile to assess the effectiveness of screening programmes using the identification of disease or tumours (...) of self-examination for breast cancer screening in women. In practice, the review focused on the effectiveness of self-examination training programmes for preventing death from breast cancer. Searching MEDLINE, PREMEDLINE, CINAHL, HealthSTAR, Current Contents and the Cochrane Library were searched from 1966 to October 2000 for English language publications describing studies in humans. The keywords used were 'breast self-examination,' 'breast diseases,' 'palpation,' 'clinical trials' and 'mass

[The effects of extending the use of mammography screening: a report on the cost-effectiveness of breast cancer screening in 60 to 69 year-old women] Rintasyopaseulonnan laajentamisen vaikutukset - Selvitys mammografiaan perustuvan rintasyopaseulonnan kustannus-vaikuttavuudesta 60-69 -vuotiailla naisilla [The effects of extending the use of mammography screening: a report on the cost-effectiveness of breast cancer screening in 60 to 69 year-old women] Rintasyopaseulonnan laajentamisen (...) vaikutukset - Selvitys mammografiaan perustuvan rintasyopaseulonnan kustannus-vaikuttavuudesta 60-69 -vuotiailla naisilla [The effects of extending the use of mammography screening: a report on the cost-effectiveness of breast cancer screening in 60 to 69 year-old women] Saarenmaa I, Salminen T, Varonen H, Fredriksson M, Sintonen H, Makela M Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has

14 years of follow-up from the Edinburgh randomised trial of breast-cancer screening. The Edinburgh randomised trial of breast-cancer screening recruited women aged 45-64 years from 1978 to 1981 (cohort 1), and those aged 45-49 years during 1982-85 (cohorts 2 and 3). Results based on 14 years of follow-up and 270,000 woman-years of observation are reported.Breast-cancer mortality rates in the intervention group (28,628 women offered screening) were compared with those in the control group (...) (26,026) with adjustment for socioeconomic status (SES) of general medical practices. Rate ratios were derived by means of logistic regression for the total trial population and for women first offered screening while younger than 50 years. Analyses were by intention to treat.Initial unadjusted results showed a difference of just 13% in breast-cancer mortality rates between the intervention and control groups (156 deaths [5.18 per 10,000] vs 167 [6.04 per 10,000]; rate ratio 0.87 [95% CI 0.70-1.06

the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Sestamibi scintimammography for screening women with dense breasts for breast cancer. As a nuclear medicine technique, this procedure is based on the enhanced uptake of sestamibi in tumours in the breast and elsewhere. Type of intervention Screening. Economic study (...) breasts for breast cancer. Breast Cancer Research and Treatment 1999; 55(3): 243-258 PubMedID Indexing Status Subject indexing assigned by NLM MeSH Adult; Breast /anatomy & Breast Neoplasms /economics /metabolism /radionuclide imaging; Cost-Benefit Analysis; Decision Trees; Female; Humans; Mammography /economics /methods; Mass Screening /economics /methods; Middle Aged; Radionuclide Imaging /economics /methods; Radiopharmaceuticals /pharmacokinetics; Risk Factors; Sensitivity and Specificity

, and it is not well described in the majority of studies. Also, the available studies included women differing in age, history of symptoms (symptomatic and asymptomatic) and practice setting (primary care or surgical). Authors' conclusions The indirect evidence supports the effectiveness of CBE in screening for breast cancer. While the screening clinical examination by itself does not rule out disease, the high specificity of certain abnormal findings greatly increases the probability of breast cancer. An overall (...) Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? Barton M B, Harris R, Fletcher S W Authors' objectives To collect evidence on the effectiveness of clinical breast examination (CBE) in screening for breast cancer, and information

, Heinonen O P. The cost-effectiveness of nationwide breast carcinoma screening in Finland, 1987-1992. Cancer 1999; 86(4): 638-646 PubMedID Original Paper URL Indexing Status Subject indexing assigned by NLM MeSH Breast Neoplasms /economics /radiography; Cost-Benefit Analysis; Female; Finland; Health Care Costs; Humans; Mammography /economics; Mass Screening /economics; Middle Aged; Retrospective Studies; Survival Analysis AccessionNumber 21999001528 Date bibliographic record published 31/07/2000 Date (...) The cost-effectiveness of nationwide breast carcinoma screening in Finland, 1987-1992 The cost-effectiveness of nationwide breast carcinoma screening in Finland, 1987-1992 The cost-effectiveness of nationwide breast carcinoma screening in Finland, 1987-1992 Leivo T, Sintonen H, Tuominen R, Hakama M, Pukkala E, Heinonen O P Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods

limitations to their study. Source of funding None stated. Bibliographic details Boer R, de Koning H J, van der Maas P J. A longer breast carcinoma screening interval for women age older than 65 years? Cancer 1999; 86(8): 1506-1510 PubMedID Indexing Status Subject indexing assigned by NLM MeSH Age Factors; Aged; Aged, 80 and over; Breast Neoplasms /diagnosis; Cost-Benefit Analysis; Female; Humans; Mammography /economics /methods; Mass Screening /economics /methods; Middle Aged; Time Factors (...) +)). The sensitivity for these five states was 0.4 for DCIS, 0.65 for T1a, 0.8 for T1b, 0.9 for T1c and 0.95 for T2+ ,(age 50+). Other results of the review were not reported. Measure of benefits used in the economic analysis The measures of benefits used were the number of breast cancer deaths prevented, the number of life years gained, the extra incidence of breast carcinoma (defined as the cases that would not have been detected without screening because the woman would have died of other causes before

cancer in the no-screening strategy was 2 years. The median survival when contracting an incurable breast cancer was estimated to be 3 years. The annual number of women who die in Norway because of breast cancer was about 800, corresponding to an incidence rate of 38% for this malignancy. The frequency of MRM in the no-screening strategy was about 15.5% versus 7% in the screening strategy. 16% were calculated to undergo adjuvant hormonal therapy (AHT) if screened and 30% if those not screened. About (...) through 10 years follow-up, the corresponding figures when screening was used were raised because of reduced mortality to 86%. Methods used to derive estimates of effectiveness Assumptions about effectiveness were made by the authors. Estimates of effectiveness and key assumptions The frequency of BCS in the treatment of breast cancer in the no-screening strategy (after a 2-year delay in diagnosis) was 25%. The frequency of TI tumours less than 20 mm was assumed to be 70% in the screening scenario

1988 to 1996. The price year used was not stated. Source of effectiveness data The estimate for final outcomes was based on a review of previously completed studies. Modelling A statistical/mathematical model of breast cancer screening was developed, in which the processes of tumour origination and growth, detection of tumours at screening, presentation of women with cancers to their GP, and of survival after diagnosis were modelled parametrically. Outcomes assessed in the review The outcome (...) Use of a mathematical model to evaluate breast cancer screening policy Use of a mathematical model to evaluate breast cancer screening policy Use of a mathematical model to evaluate breast cancer screening policy Baker R D Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study

Mammography screening as a method for the early detection of breast cancer Mammography screening as a method for the early detection of breast cancer Mammography screening as a method for the early detection of breast cancer Gibis B, Busse R, Reese E, Richter K, Schwartz FW, Koebberling J Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation (...) Gibis B, Busse R, Reese E, Richter K, Schwartz FW, Koebberling J. Mammography screening as a method for the early detection of breast cancer. German Agency for Health Technology Assessment at the German Institute for Medical Documentation and Information (DAHTA@ DIMDI). 1998 Authors' objectives This report aims to answer the following questions: - To what extent are reductions in the efficacy of a mammography screening programme with a participation rate of under 70% to be tolerated? - What quality

The costs of treating breast cancer in the United Kingdom: implications for screening The costs of treating breast cancer in the United Kingdom: implications for screening The costs of treating breast cancer in the United Kingdom: implications for screening Wolstenholme J L, Smith S J, Whynes D K Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions (...) followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Screening for breast cancer. Type of intervention Screening. Economic study type Cost-effectiveness analysis. Study population The treatment cost analysis was based on the case notes of 137 breast cancer patients. 102 patients had stage 1 cancer, 13 stage 2, 16 stage 3 and 6 had stage 4 cancer. This information was used to determine the screening scenario for the 2,687 new breast

screen populations, the review assessed: the frequency of screen-detected breast cancers by first screen and second screen, after one year; and information on lymph node spread, tumour size, mortality, probability of treatment and life expectancy. Study designs and other criteria for inclusion in the review The effectiveness estimates were mainly taken from the Taiwan Multicentre Cancer Screening Study. Sources searched to identify primary studies Not stated. Criteria used to ensure the validity (...) , Yen M F, Kuo H S, Koong S L, Chen T H, Duffy S W. Efficacy of breast-cancer screening for female relatives of breast-cancer-index cases: Taiwan multicentre cancer screening (TAMCAS) International Journal of Cancer 1998; 78(1): 21-26 Indexing Status Subject indexing assigned by NLM MeSH Breast Neoplasms /diagnosis /mortality /pathology /epidemiology; Family Health; Female; Humans; Incidence; Lymphatic Metastasis; Mass Screening /standards; Program Evaluation; Research Support, Non-U.S. Gov't

Efficacy of reverse transcriptase-polymerase chain reaction screening for micrometastatic disease in axillary lymph nodes of breast cancer patients Efficacy of reverse transcriptase-polymerase chain reaction screening for micrometastatic disease in axillary lymph nodes of breast cancer patients Efficacy of reverse transcriptase-polymerase chain reaction screening for micrometastatic disease in axillary lymph nodes of breast cancer patients Lockett M A, Metcalf J S, Baron P L, O'Brien P H (...) , Elliott B M, Robison J G, Cole D J Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Reverse transcriptase-polymerase chain reaction (RT-PCR) screening for micrometastatic disease in axillary lymph nodes of breast cancer patients. Type

for mammography screening for all women in this age group and that the survival benefit and diagnosis at an earlier stage outweigh the potential risks.3 Introduction Breast cancer is the single leading cause of death for women ages 40Ð49 in the United States. A 40-year-old woman has a 2 percent chance of being diagnosed with invasive breast cancer or ductal carcinoma in situ in the next 10 years, and her chance of dying from breast cancer during this decade is 0.3 percent. In addition to morbidity (...) and mortality from breast cancer itself, a toll is taken by the emotional impact of both the disease and its treatment and by the fear engendered from the threat of developing the disease. To what extent can early detection through mammographic screening reduce the impact of breast cancer in women in their forties, and what risks may be associated with mammog- raphy in this age group? Although nonrandomized observa- tional data on women screened with mammography have been reported, the benefits and risks