Advertisement

Treatment Intensity Differences According to Participation in a Population Screening Program

  • G. B. Mann
  • C. Nickson
  • K. Elder
Breast Oncology

To the Editors:

We thank Dr. Lannin for his editorial interest1 in our paper ‘Treatment Intensity Differences After Early-Stage Breast Cancer (ESBC) Diagnosis Depending on Participation in a Screening Program’.2 We believe that much of his analysis stems from a misunderstanding of the nature of our study and a number of questionable assumptions.

Our study assesses differences in breast cancer pathology and treatment according to screening status, combining outcomes for screen-detected and interval cancers among recent screening participants. We agree that length of time bias (screening detecting more favorable cancers) arises when screen-detected cancers are compared with all other cancers in the community. This bias is carefully minimized in this study by combining interval cancers and screen-detected cancers in the ‘active screeners’ group, and then excluding likely overdiagnosed screen-detected cancers from our analysis.

Dr. Lannin’s re-analysis of our published figures purports to...

References

  1. 1.
    Lannin DR. Treatment Intensity for Mammographically Detected Tumours: An Alternative Viewpoint. Ann Surg Oncol. 2018;25(9):2502-2505.CrossRefGoogle Scholar
  2. 2.
    Elder K, et al. Treatment intensity differences after early-stage breast cancer (ESBC) diagnosis depending on participation in a screening program. Ann Surg Oncol. 2018;25(9):2563–72.CrossRefGoogle Scholar
  3. 3.
    Australian Institute of Health and Welfare. BreastScreen Australia monitoring report 2014–2015. Cancer series no. 106. Cat. no. CAN 105. Canberra, ACT: AIHW; 2017.Google Scholar
  4. 4.
    Welch HG, et al. Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness. N Engl J Med. 2016;375:1438–47.CrossRefGoogle Scholar
  5. 5.
    Puliti D, et al. Overdiagnosis in mammographic screening for breast cancer in Europe: a literature review. J Med Screen. 2012;19(Suppl 1):42–56.CrossRefGoogle Scholar
  6. 6.
    Marmot M, et al. Independent UK Panel on Breast Cancer Screening. The benefits and harms of breast cancer screening: an independent review. Lancet. 2012;380:1778–86.CrossRefGoogle Scholar
  7. 7.
    Beckmann K, et al. Estimates of over-diagnosis of breast cancer due to population-based mammography screening in South Australia after adjustment for lead time effects. J Med Screen. 2015;22:127–35.CrossRefGoogle Scholar
  8. 8.
    Martelotto LG, et al. Breast cancer intra-tumour heterogeneity. Breast Cancer Res. 2014;16:210.CrossRefGoogle Scholar
  9. 9.
    Duffy S, et al. Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study. Lancet Oncol. 2016;17:109–114.CrossRefGoogle Scholar
  10. 10.
    Bedrosian I. Screening mammography: getting to version 2.0. Ann Surg Oncol. 2018;25(9):2500–01.CrossRefGoogle Scholar
  11. 11.
    Esserman L. The WISDOM Study: breaking the deadlock in the breast cancer screening debate. NPJ Breast Cancer. 2017;3:34.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  1. 1.The Breast Service, Royal Melbourne and Royal Women’s HospitalParkvilleAustralia
  2. 2.Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia

Personalised recommendations