eMedicineLive

A trend analysis of the database of mortality of the World Health Organization (WHO) shows that there has been a decrease in the rate of mortality associated with breast cancer. However, this falling rate of breast cancer deaths cannot be attributed to the screening tests used to detect breast cancer. This was the result of a study recently published in the British Medical Journal. The study led by an international team of researchers from France, the UK and Norway found that breast cancer screening has not played a direct part in the reduction of breast cancer deaths. Rather, the falling numbers may be because of better treatment and improving health systems.

 

In Nordic countries which implemented nationwide screening programs between the periods of 1965 to 1980, experienced an early fall in mortality due to cervical cancer. The researchers expected something similar in case of breast cancer too. So they used a similar approach to compare trends in breast cancer mortality within three pairs of European countries – Northern Ireland versus Republic of Ireland, the Netherlands versus Belgium and Flanders, and Sweden versus Norway. All the countries had similar level of risk factors for breast cancer mortality and had comparable healthcare services. However, the mammography screening was implemented about 10 to 15 years later in the second country of each pair. 

 

Going by the experience of Nordic countries, the researchers expected that a reduction in breast cancer mortality would appear sooner in countries with earlier implementation of screening. They studied data from the World Health Organization (WHO) mortality database and found that the fall in mortality rate because of breast cancer was irrespective of the time of introduction of screening for the disease. The trends showed little variation in between countries where women had been screened by mammography for a considerable time compared with those where women were largely unscreened during that same period. Moreover, the falling rates were most prominent in the age groups of 40 to 49 years irrespective of availability of screening.

 

The researchers concluded that screening tests do not have a direct role in the falling mortality rates of breast cancer. Improvements in treatment and in the efficiency of healthcare systems may be playing a major role in these trends.

 

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