programas cribado cancer


Nota Bibliográfica

Esta Nota es una recopilación de publicaciones (artículos, informes, libros) sobre cribado de cáncer resultado de una revisión no sistemática de la literatura.

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Josep A Espinás. Pla Director d'Oncología de Catalunya.
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Nota bibliográfica cribado c mama 2014-02

Miller AB, Wall C, Baines CJ, Sun P, To T, Narod SA. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial. BMJ. 2014;348. Available from:

Conclusion Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available. Overall, 22% (106/484) of screen detected invasive breast cancers were over-diagnosed, representing one over-diagnosed breast cancer for every 424 women who received mammography screening in the trial.

Kalager M, Adami H-O, Bretthauer M. Too much mammography. BMJ. 2014;348.

Yaffe MJ, Pritchard KI. Overdiagnosing Overdiagnosis. Oncologist. 2014;19(2):103–6. Available from: doi: 10.1634/theoncologist.2014-0036.

Christiansen P, Vejborg I, Kroman N, Holten I, Garne JP, Vedsted P, et al. Position paper: Breast cancer screening, diagnosis, and treatment in Denmark. Acta Oncol (Madr). 2014;1–12. Available from: doi: 10.3109/0284186X.2013.874573.
Breast cancer treatment in Denmark is evidence based and in agreement with international recommendations. After the introduction of mammography screening the absolute number of patients with a more advanced stage at diagnosis and the absolute number of patients undergoing mastectomy have decreased.

Kopans DB. Arguments Against Mammography Screening Continue to be Based on Faulty Science. Oncologist. 2014;19(2):107–12. Available from: doi: 10.1634/theoncologist.2013-0184.

Bleyer A. Were Our Estimates of Overdiagnosis With Mammography Screening in the United States “Based on Faulty Science”? Oncologist. 2014;19(2):113–26. Available from: doi: 10.1634/theoncologist.2013-0383.

Arie S. Switzerland debates dismantling its breast cancer screening programme. BMJ. 2014;348.

A row has erupted in Switzerland after the Swiss Medical Board recommended that the country’s mammography screening programme for breast cancer be suspended because it leads to too many unnecessary interventions.In a report made public on 2 February, the board said that while systematic mammography screening for breast cancer saved 1-2 women’s lives for every 1000 screened, it led to unnecessary investigations and treatment for around 100 women in every 1000.1“The desirable effect is offset by the undesirable effects,” said the report, which was based on study data from …

Latosinsky S, Bryant HE, Newman LA. FORMATION MÉDICALE CONTINUE CAGS AND ACS EVIDENCE BASED REVIEWS IN SURGERY . 48 . What is the effect of screening mammography on breast cancer incidence ? Contin Med Educ. 2014;57(1):67–9. doi: 10.1503/cjs.032913.

Dibden A, Offman J, Parmar D, Jenkins J, Slater J, Binysh K, et al. Reduction in interval cancer rates following the introduction of two-view mammography in the UK breast screening programme. Br J Cancer. 2014;110(3):560–4. Available from: doi: 10.1038/bjc.2013.778. PMID: 24366303.

Conclusion:The introduction of two-view mammography at incident screens is associated with a reduction in incidence of interval cancers. This is consistent with previous publications on a contemporaneous increase in screen-detected cancers. The results provide further evidence of the benefit of the use of two-view mammography at incident screens.

Vilaprinyo E, Forné C, Carles M, Sala M, Pla R, Castells X, et al. Cost-Effectiveness and Harm-Benefit Analyses of Risk-Based Screening Strategies for Breast Cancer. Sapino A, editor. PLoS One. 2014;9(2):e86858. Available from: doi: 10.1371/journal.pone.0086858.

The one-size-fits-all paradigm in organized screening of breast cancer is shifting towards a personalized approach. The present study has two objectives: 1) To perform an economic evaluation and to assess the harm-benefit ratios of screening strategies that vary in their intensity and interval ages based on breast cancer risk; and 2) To estimate the gain in terms of cost and harm reductions using risk-based screening with respect to the usual practice. We used a probabilistic model and input data from Spanish population registries and screening programs, as well as from clinical studies, to estimate the benefit, harm, and costs over time of 2,624 screening strategies, uniform or risk-based. We defined four risk groups, low, moderate-low, moderate-high and high, based on breast density, family history of breast cancer and personal history of breast biopsy. The risk-based strategies were obtained combining the exam periodicity (annual, biennial, triennial and quinquennial), the starting ages (40, 45 and 50 years) and the ending ages (69 and 74 years) in the four risk groups. Incremental cost-effectiveness and harm-benefit ratios were used to select the optimal strategies. Compared to risk-based strategies, the uniform ones result in a much lower benefit for a specific cost. Reductions close to 10% in costs and higher than 20% in false-positive results and overdiagnosed cases were obtained for risk-based strategies. Optimal screening is characterized by quinquennial or triennial periodicities for the low or moderate risk-groups and annual periodicity for the high-risk group. Risk-based strategies can reduce harm and costs. It is necessary to develop accurate measures of individual risk and to work on how to implement risk-based screening strategies.

Coldman AJ, Phillips N. Breast cancer survival and prognosis by screening history. Br J Cancer. 2014;110(3):556–9. Available from:
Interpretation: There was no evidence that cancers diagnosed within 12 months had poorer prognosis than those diagnosed up to 48 months following screening


Nota bibliográfica cribado c mama 2014-01

Puig-Vives M, Osca-Gelis G, Camprubí-Font C, Vilardell ML, Izquierdo A, Marcos-Gragera R. Proporción de cáncer de mama en mujeres de 50 a 69 años de Girona según el método de detección. Med Clin (Barc). (0). Available from: doi:

Conclusiones Durante los primeros años del funcionamiento del PDPCM (2002-2006) los casos de cáncer de intervalo representaron un porcentaje bajo (5,8%) respecto el total de CM diagnosticados en mujeres de 50 a 69 años en la provincia de Girona.

García Fernández A, Chabrera C, García Font M, Fraile M, Lain JM, Gónzalez S, et al. Mortality and recurrence patterns of breast cancer patients diagnosed under a screening programme versus comparable non-screened breast cancer patients from the same population: analytical survey from 2002 to 2012. Tumour Biol. 2013; Available from: doi: 10.1007/s13277-013-1260-7. PMID: 24114015.

 Breast cancer screening programmes seem to bring about significant benefits, including decreased mortality, although they may also have some drawbacks such as false-negative and false-positive results. This study aims to compare the clinical outcome of a group of patients undergoing a breast cancer screening programme with that of a synchronous non-screened group of patients matched for age and follow-up period. We studied basic characteristics of epidemiology, immunohistochemistry, loco-regional relapse, distant metastases, disease-free interval and overall and specific mortality. We compared 510 patients in the screened group with 394 non-screened patients, along the period of 2002-2012. Screening was applied on a target population of 49,847 and was based on double-projection, double-read mammograms. Two years were allowed per round. Overall participation for the five rounds considered was 75.2 %, with 86.5 % coverage, and a total cumulative population of 123,445. The non-participant women amounted 40,794. Tumour detection rate for the screened women was 3.8 per thousand (475/123,445), while the corresponding rate for non-participants was 9.4 per thousand (382/40,797). Incidence of luminal A subtype was 15 % higher in screened than that in non-screened patients (95 % confidence interval (CI) 8-22 %). Conversely, the triple-negative subtype was 6 % higher in the non-screened group (95 % CI 2-10 %). Incidence of breast conservative treatments and sentinel node biopsies was significantly higher in the screened group. Overall mortality was 2.6 times higher in non-screened than that in screened group (95 % CI 1.2-5.6) After 10 years of experience with our own screening programme, we believe that included patients receive a benefit versus comparable non-screened breast cancer patients, with acceptable benefit-risk relation.

MA S, Hamel M, RB D, Al E. Development and evaluation of a decision aid on mammography screening for women 75 years and older. JAMA Intern Med. 2013; Available from:

CONCLUSIONS: A DA may improve older women’s decision making about
mammography screening.

Rafferty EA, Park JM, Philpotts LE, Poplack SP, Sumkin JH, Halpern EF, et al. Diagnostic Accuracy and Recall Rates for Digital Mammography and Digital Mammography Combined With One-View and Two-View Tomosynthesis: Results of an Enriched Reader Study. Am J Roentgenol. 2014;202(2):273–81. Available from: doi: 10.2214/AJR.13.11240.

CONCLUSION. The addition of one-view tomosynthesis to conventional digital mammography improved diagnostic accuracy and reduced the recall rate; however, the addition of two-view tomosynthesis provided twice the performance gain in diagnostic accuracy while further reducing the recall rate.

Plecha D, Salem N, Kremer M, Pham R, Downs-Holmes C, Sattar A, et al. JOURNAL CLUB: Neglecting to Screen Women Between 40 and 49 Years Old With Mammography: What Is the Impact on Treatment Morbidity and Potential Risk Reduction? Am J Roentgenol. 2014;202(2):282–8. Available from: doi: 10.2214/AJR.13.11382.

CONCLUSION. In addition to the benefits of receiving a diagnosis at earlier stages, with smaller tumors and node negativity, patients with breast cancer undergoing screening mammography aged 40?49 years are less likely to require chemotherapy and its associated morbidities. The majority of high-risk lesions were diagnosed in the screened group, which may lead to the benefit of chemoprevention, lowering their risk of subsequent breast cancer, or screening with MRI, which may diagnose future mammographically occult malignancies.

Javitt MC. Section Editor’s Notebook: Breast Cancer Screening and Overdiagnosis Unmasked. Am J Roentgenol. 2014;202(2):259–61. Available from: doi: 10.2214/AJR.13.12052.

Kopans DB. Digital Breast Tomosynthesis From Concept to Clinical Care. Am J Roentgenol. 2014;202(2):299–308. Available from: doi: 10.2214/AJR.13.11520.

CONCLUSION. Mammographic screening has dramatically reduced breast cancer deaths, but it does not depict all cancer early enough to result in a cure. In addition, because of the recall rates associated with mammography, efforts are underway to reduce access to screening. Use of DBT improves sensitivity and specificity, and there is no longer a need to obtain full-exposure 2D mammograms. DBT will replace standard 2D mammography for breast cancer screening.

Ceugnart L, Deghaye M, Vennin P, Haber S, Taieb S. Organized breast screening: Answers to recurring controversies. Diagn Interv Imaging. (0). Available from: doi:

Abstract The reduction in mortality specifically from breast cancer, demonstrated in the major meta-analyses in the 1980s resulted in public health breast cancer screening programs being set up in many countries, including France. Recent publications have challenged the usefulness of screening, by insisting in particular on the negative effects of overdiagnosis and the lack of any significant impact on mortality. From analysis of the literature and particularly independent reviews published in 2012, we provide some answers for doctors faced with the legitimate concerns of women. These studies confirm that screening in the right age group reduces specific mortality by at least 20% at a cost of overdiagnosis estimated at between 1 and 15%.

Welch H, HJ P. Quantifying the benefits and harms of screening mammography. JAMA Intern Med. 2013; Available from:

 Like all early detection strategies, screening mammography involves trade-offs. If women are to truly participate in the decision of whether or not to be screened, they need some quantification of its benefits and harms. Providing such information is a challenging task, however, given the uncertainty—and underlying professional disagreement—about the data. In this article, we attempt to bound this uncertainty by providing a range of estimates—optimistic and pessimistic—on the absolute frequency of 3 outcomes important to the mammography decision: breast cancer deaths avoided, false alarms, and overdiagnosis. Among 1000 US women aged 50 years who are screened annually for a decade, 0.3 to 3.2 will avoid a breast cancer death, 490 to 670 will have at least 1 false alarm, and 3 to 14 will be overdiagnosed and treated needlessly. We hope that these ranges help women to make a decision: either to feel comfortable about their decision to pursue screening or to feel equally comfortable about their decision not to pursue screening. For the remainder, we hope it helps start a conversation about where additional precision is most needed.

Health Council of the Netherlands. Health Council of the Netherlands. Population screening for breast cancer: expectations and developments. The Hague; 2014.

Health Council of the Netherlands. Population screening for breast cancer: expectations and developments. The Hague: Health Council of the Netherlands, 2014; publication no. 2014/01. ISBN 978-90-5549-991-5


Nota bibliográfica cribado c mama 2013-12

Rauscher GH, Murphy AM, Orsi JM, Dupuy DM, Grabler PM, Weldon CB. Beyond the Mammography Quality Standards Act: Measuring the Quality of Breast Cancer Screening Programs. Am J Roentgenol. 2013;202(1):145–51. Available from: doi: 10.2214/AJR.13.10806.

CONCLUSION. The results suggest a combination of quality of care issues and incomplete tracking of patients. To accurately measure the quality of the breast cancer screening process, it is critical that there be complete tracking of patients with abnormal screening mammography findings so that results can be interpreted solely in terms of quality of care. The MQSA guidelines for tracking outcomes and measuring quality indicators should be strengthened for better assessment of quality of care.

Hale PJ, DeValpine MG. Screening Mammography: Revisiting Assumptions About Early Detection. J Nurse Pract. 2013; Available from:

Recommendations for the frequency of mammography screening vary across several professional advisory groups. In 2009, the United States Preventive Services Task Force Guidelines reduced screening to biennially for women 50-74 years old. Drivers of this change were false-positive results and unnecessary biopsies, exposure to radiation, and treatment of cancers that would never develop. Despite the recommendation, surveys show that screening has actually increased since the change. A review of the individual woman’s risk and a more balanced approach addressing both the benefits and harms of screening is required so that patients can make an informed choice.

Séradour B, Heid P, Estève J. Comparison of Direct Digital Mammography, Computed Radiography, and Film-Screen in the French National Breast Cancer Screening Program. Am J Roentgenol. 2013;202(1):229–36. Available from: doi: 10.2214/AJR.12.10419.

CONCLUSION. Direct digital mammography has a higher detection rate than film-screen mammography in dense breasts and for tumors of high grade. This latter association warrants further study to measure the impact of technology on efficacy of screening. The data indicate that computed radiography detects fewer tumors than film-screen mammography in most instances.

Lee CH. Radiologic Screening for Breast Cancer: Current Controversies. Curr Radiol Rep. 2013;2(2):34. Available from: doi: 10.1007/s40134-013-0034-8.

 Abstract Breast cancer is the most commonly occurring cancer, aside from skin cancer, among American women and the second leading cause of cancer death. Screening with mammography has been used for decades in this country, and since its introduction, there has been a reduction in breast cancer mortality. However, controversy surrounding the use of mammography to screen for breast cancer continues. In addition, the development of newer imaging techniques that can be applied to breast cancer screening has generated further debate about the value and appropriate use of radiologic imaging for breast cancer screening.

Strech D. Participation rate or informed choice? Rethinking the European key performance indicators for mammography screening. Health Policy (New York). (0). Available from: doi:

 Abstract Despite the intensive controversies about the likelihood of benefits and harms of mammography screening almost all experts conclude that the choice to screen or not to screen needs to be made by the individual patient who is adequately informed. However, the “European guideline for quality assurance in breast cancer screening and diagnosis” specifies a participation rate of 70% as the key performance indicator for mammography screening. This paper argues that neither the existing evidence on benefits and harms, nor survey research with women, nor compliance rates in clinical trials, nor cost-effectiveness ratios justify participation rates as a reasonable performance indicator for preference-sensitive condition such as mammography screening. In contrast, an informed choice rate would be more reasonable. Further research needs to address the practical challenges in assessing informed choice rates.

Eklund M, Esserman LJ. Screening: Biology dictates the fate of young women with breast cancer. Nat Rev Clin Oncol. 2013;10(12):673–5. Available from:

Kerrison R, Shukla H, Cunningham D, Oyebode O, Friedman E. Are text message reminders an effective intervention to improve uptake of breast
screening? A randomised controlled trial
. Lancet. 2013;382:S9. Available from: doi: 10.1016/S0140-6736(13)62434-4.

 Interpretation Receipt of a text message reminder 48 h before a scheduled breast screening appointment signifi cantly improves uptake. To ensure that the benefi ts of text message reminders are achieved, work is needed to improve patient mobile records.


Nota bibliográfica cribado c mama 2013-11

Arleo EK, Dashevsky BZ, Reichman M, Babagbemi K, Drotman M, Rosenblatt R. Screening Mammography for Women in Their 40s: A Retrospective Study of the Potential Impact of the U.S. Preventive Service Task Force’s 2009 Breast Cancer Screening Recommendations. Am J Roentgenol. 2013;201(6):1401–6. Available from: doi:10.2214/AJR.12.10390.
CONCLUSION. From 2007 through 2010, patients in their 40s accounted for one third of the population undergoing screening mammography and for nearly 20% of the screeningdetected breast cancers—more than half of which were invasive. This information should be a useful contribution to counseling women in this age group when discussing whether or not to pursue regular screening mammography.

Hoff SR, Klepp O, Hofvind S. Asymptomatic breast cancer in non-participants of the national screening-programme in Norway: a confounding factor in evaluation? J Med Screen. 2013; Available from: doi: 10.1177/0969141313476633. PMID: 24009086.
CONCLUSIONS: A considerable percentage of breast cancers detected outside the organized screening programme were asymptomatic, with a prognostic profile comparable with screening-detected breast cancers in the NBCSP. Individual data regarding the detection method for all breast cancers are needed for a complete evaluation of the organized screening programme in Norway.

Beckmann KR, Roder DM, Hiller JE, Farshid G, Lynch JW. Do breast cancer risk factors differ among those who do and do not undertake mammography screening? J Med Screen. 2013; Available from: doi: 10.1177/0969141313510293. PMID: 24153439.
CONCLUSIONS: South Australian women who participated in the population-based mammography screening have a slightly higher prevalence of breast cancer risk factors. This also applies to those who undertook private screening


Nota bibliográfica cribado c mama 2013-10

Apesteguía Ciriza L, Pina Insausti LJ. Cribado poblacional de cáncer de mama. Certezas, controversias y perspectivas de futuro. Radiologia. (0). Available from: doi:

Resumen Los programas poblacionales de detección precoz del cáncer de mama basados en la mamografía deben mantener un alto nivel de calidad y sus resultados han de ser permanentemente monitorizados. Aunque la mayoría de autores consideran que estos programas han disminuido la mortalidad por cáncer de mama aproximadamente un 30%, no faltan voces críticas. Algunos autores sostienen que la reducción de la mortalidad es inferior, aproximadamente del 12%, por errores en la aleatorización de pacientes, porque la tasa de tumores avanzados apenas ha disminuido y porque los tratamientos adyuvantes también mejoran la supervivencia. Otras críticas se centran también en el sobrediagnóstico y el sobretratamiento. Creemos que a pesar del indudable valor del cribado mamográfico, debemos estar abiertos a ciertos cambios, como la estratificación de las pacientes por nivel de riesgo y la introducción de técnicas complementarias a la mamografía, como la tomosíntesis, la ecografía y la resonancia magnética en casos seleccionados

Nederend J, Duijm LEM, Louwman MWJ, Coebergh JW, Roumen RMH, Lohle PN, et al. Impact of the transition from screen-film to digital screening mammography on interval cancer characteristics and treatment – A population based study from the Netherlands. Eur J Cancer. 2013;
Available from: doi: 10.1016/j.ejca.2013.09.018.

Ozanne EM. Overdiagnosis and Overtreatment of Breast Cancer: How Can We Promote Informed Patient Choice? Curr Breast Cancer Rep. 2013; Available from: doi: 10.1007/s12609-013-0128-6.

Gur D, Sumkin JH. Screening for Early Detection of Breast Cancer: Overdiagnosis versus Suboptimal Patient Management. Radiology. 2013;268(2):327–8. Available from: doi: 10.1148/radiol.13122721.     PMID: 23882095.

Wickerham DL, Julian TB. Ductal Carcinoma In Situ: A Rose by Any Other Name. J Natl Cancer Inst. 2013;
Available from:
doi: 10.1093/jnci/djt268.

Punglia RS, Schnitt SJ, Weeks JC. Treatment of Ductal Carcinoma In Situ After Excision: Would a Prophylactic Paradigm Be More Appropriate? J Natl Cancer Inst. 2013; Available from: doi: 10.1093/jnci/djt256.

Corresponding to the increased use of mammography, the incidence of ductal carcinoma in situ (DCIS) has risen dramatically in the past 30 years. Despite its growing incidence, the treatment of DCIS remains highly variable and controversial. Although DCIS itself does not metastasize and is never lethal, it may be a precursor of invasive breast cancer and is a marker of increased breast cancer risk. Confusing a precursor lesion with cancer, many clinicians apply an invasive breast cancer treatment paradigm to DCIS patients, offering adjuvant radiation therapy and tamoxifen after diagnosis. In this commentary, we outline the issues associated with DCIS management—is DCIS a cancer, a precursor of cancer, or a marker of invasive carcinoma risk? Specifically, we argue that consideration be given to removing the term “carcinoma” from DCIS, using cancer “occurrence” to mean the diagnosis of invasive cancer after DCIS instead of “recurrence,” and make the argument that a prophylactic paradigm of treatment after excision may be more appropriate.
Marmot MG, Altman DG, Cameron D a, Dewar J a, Thompson SG, Wilcox M. The benefits and harms of breast cancer screening: an independent review. Br J Cancer. 2013;108(11):2205–40. Available from: doi: 10.1038/bjc.2013.177. PMID: 23744281.

Ripping TM, Verbeek a LM, van der Waal D, Otten JDM, den Heeten GJ, Fracheboud J, et al. Immediate and delayed effects of mammographic screening on breast cancer mortality and incidence in birth cohorts. Br J Cancer. 2013;(October):1–5. Available from:
doi: 10.1038/bjc.2013.627.  PMID: 24113141.

Conclusion:When applying a trend study to estimate the impact of mammographic screening, we recommend using a birth cohort approach.British Journal of Cancer advance online publication, 10 October 2013; doi:10.1038/bjc.2013.627

Duffy SW, Chen TH, Smith RA. Real and artificial controversies in breast cancer screening. Breast Cancer Manag. 2013;2(6):519–28.
Available from:
doi: 10.2217/bmt.13.53.

SUMMARY We review the apparent disparities between different reviews of the effects of mammographic screening on mortality from breast cancer and overdiagnosis. When results of each review are expressed with respect to a common population and a common baseline, all find a substantial mortality benefit and variation among estimates is minor. There are genuine disagreements about overdiagnosis, but methods that take account of lead time and underlying incidence trends yield estimates of overdiagnosis that are modest and are outweighed by the mortality benefit. There is potential for individualized screening regimens, particularly with respect to breast density


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