Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Dec 5:359:j5224.
doi: 10.1136/bmj.j5224.

Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study

Philippe Autier  1   2 , Magali Boniol  2 , Alice Koechlin  3   2 , Cécile Pizot  2 , Mathieu Boniol  3   2
Affiliations

Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study

Philippe Autier et al. BMJ. .

Abstract

Objective To analyse stage specific incidence of breast cancer in the Netherlands where women have been invited to biennial mammography screening since 1989 (ages 50-69) and 1997 (ages 70-75), and to assess changes in breast cancer mortality and quantified overdiagnosis.Design Population based study.Setting Mammography screening programme, the Netherlands.Participants Dutch women of all ages, 1989 to 2012.Main outcome measures Stage specific age adjusted incidence of breast cancer from 1989 to 2012. The extra numbers of in situ and stage 1 breast tumours associated with screening were estimated by comparing rates in women aged 50-74 with those in age groups not invited to screening. Overdiagnosis was estimated after subtraction of the lead time cancers. Breast cancer mortality reductions and overdiagnosis during 2010-12 were computed without (scenario 1) and with (scenario 2) a cohort effect on mortality secular trends.Results The incidence of stage 2-4 breast cancers in women aged 50 or more was 168 per 100 000 in 1989 and 166 per 100 000 in 2012. Screening would be associated with a 5% mortality reduction in scenario 1 and with no influence on mortality in scenario 2. In both scenarios, improved treatments would be associated with 28% reductions in mortality. Overdiagnosis has steadily increased over time with the extension of screening to women aged 70-75 and with the introduction of digital mammography. After deduction of clinical lead time cancers, 33% of cancers found in women invited to screening in 2010-12 and 59% of screen detected cancers would be overdiagnosed.Conclusions The Dutch mammography screening programme seems to have little impact on the burden of advanced breast cancers, which suggests a marginal effect on breast cancer mortality. About half of screen detected breast cancers would represent overdiagnosis.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE form and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Estimations of changes in breast cancer mortality in women aged 50 or more in the Netherlands due to mammography screening. Age adjusted rates are per 100 000 women aged 50 or more. The black dashed lines correspond to trends in the absence of change in rates over time
Fig 2
Fig 2
Trends in age adjusted breast cancer mortality by age group in women in the Netherlands, 1950 to 2013. Figures are the annual percentage changes (95% confidence intervals) for the two last periods with stable trend according to joinpoint analysis
Fig 3
Fig 3
Trends in age adjusted breast cancer incidence by stage in women aged 50 or more in the Netherlands, 1989 to 2012
Fig 4
Fig 4
Trends in age adjusted in situ breast cancer incidence in women by age group in the Netherlands, 1989 to 2012
Fig 5
Fig 5
Trends in age adjusted stage 1 breast cancer incidence in women by age group in the Netherlands, 1989 to 2012
See this image and copyright information in PMC

Comment in

  • Breast cancer screening.
    Kalager M. Kalager M. BMJ. 2017 Dec 6;359:j5625. doi: 10.1136/bmj.j5625. BMJ. 2017. PMID: 29212770 No abstract available.

References

    1. Morrison AS. Intermediate determinants of mortality in the evaluation of screening. Int J Epidemiol 1991;20:642-50. 10.1093/ije/20.3.642 - DOI - PubMed
    1. World Health Organization Cancer IAfRo. Cancer: Causes, Occurrence and Control. International Agency for Research on Cancer, 1990.
    1. Cole P, Morrison AS. Basic issues in population screening for cancer. J Natl Cancer Inst 1980;64:1263-72. - PubMed
    1. Greenwald P, Sondik EJ, Young JL., Jr Emerging roles for cancer registries in cancer control. Yale J Biol Med 1986;59:561-6. - PMC - PubMed
    1. Tabár L, Fagerberg CJ, Gad A, et al. Reduction in mortality from breast cancer after mass screening with mammography. Randomised trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet 1985;1:829-32. 10.1016/S0140-6736(85)92204-4 - DOI - PubMed

Publication types