scispace - formally typeset
Search or ask a question
Author

J. C. Månson

Bio: J. C. Månson is an academic researcher from International Agency for Research on Cancer. The author has contributed to research in topics: Mass screening & Breast cancer. The author has an hindex of 2, co-authored 2 publications receiving 1724 citations. Previous affiliations of J. C. Månson include Karolinska Institutet & National Board of Health and Welfare.

Papers
More filters
Journal ArticleDOI
TL;DR: 7 years after the start of the study the excess of stage I cancers in the study group largely outweighs the deficit of advanced cancers, and the results to the end of 1984 show a 31% reduction in mortality from breast cancer and a 25% reduced in the rate of stage II or more advanced breast cancers.

1,696 citations

Journal ArticleDOI
01 Nov 1985
TL;DR: The yearly incidence of stage II or more advanced breast cancers after the initial screening round up to and including the second was reduced by 40 per cent in the study group compared with the controls, and this effect was less marked in the age group 40-49.
Abstract: A randomised controlled trial of mass screening for breast cancer by single-view mammography was begun in Sweden in 1977. All women aged 40 and older and resident in the counties of Kopparberg and Ostergotland were enrolled. The present report is confined to the Ostergotland study, which started in 1978 and comprised 92934 women. After randomisation, which was done on the basis of communities rather than individuals, 47001 women were allocated to the study group and offered repeated mammographic screening; 45933 were allocated to the control group. As compliance among women over 74 years of age was poor these were excluded from the present report. The yearly incidence of stage II or more advanced breast cancers after the initial screening round up to and including the second was reduced by 40 per cent in the study group compared with the controls. This effect was less marked in the age group 40–49. After 5.5 years average from the date of entry the absolute number of women with stage II-IV disease in the ...

65 citations


Cited by
More filters
Journal ArticleDOI
TL;DR: 7 years after the start of the study the excess of stage I cancers in the study group largely outweighs the deficit of advanced cancers, and the results to the end of 1984 show a 31% reduction in mortality from breast cancer and a 25% reduced in the rate of stage II or more advanced breast cancers.

1,696 citations

Journal ArticleDOI
TL;DR: It is found that breast cancer mortality was an unreliable outcome that was biased in favour of screening, mainly because of differential misclassification of cause of death.
Abstract: Screening with mammography uses X-ray imaging to find breast cancer before a lump can be felt. The goal is to treat cancer earlier, when a cure is more likely. The review includes seven trials that involved 600,000 women in the age range 39 to 74 years who were randomly assigned to receive screening mammograms or not. The studies which provided the most reliable information showed that screening did not reduce breast cancer mortality. Studies that were potentially more biased (less carefully done) found that screening reduced breast cancer mortality. However, screening will result in some women getting a cancer diagnosis even though their cancer would not have led to death or sickness. Currently, it is not possible to tell which women these are, and they are therefore likely to have breasts or lumps removed and to receive radiotherapy unnecessarily. If we assume that screening reduces breast cancer mortality by 15% after 13 years of follow-up and that overdiagnosis and overtreatment is at 30%, it means that for every 2000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive findings. Women invited to screening should be fully informed of both the benefits and harms. To help ensure that the requirements for informed choice for women contemplating whether or not to attend a screening programme can be met, we have written an evidence-based leaflet for lay people that is available in several languages on www.cochrane.dk. Because of substantial advances in treatment and greater breast cancer awareness since the trials were carried out, it is likely that the absolute effect of screening today is smaller than in the trials. Recent observational studies show more overdiagnosis than in the trials and very little or no reduction in the incidence of advanced cancers with screening.

1,640 citations

Journal ArticleDOI
TL;DR: Mammographic sensitivity for breast cancer declines significantly with increasing breast density and is independently higher in older women with dense breasts, which significantly increases detection of small cancers and depicts significantly more cancers and at smaller size and lower stage than does PE, which detects independently extremely few cancers.
Abstract: PURPOSE: To (a) determine the performance of screening mammography, ultrasonography (US), and physical examination (PE); (b) analyze the influence of age, hormonal status, and breast density; (c) compare the size and stage of tumors detected with each modality; and (d) determine which modality or combination of modalities optimize cancer detection. MATERIALS AND METHODS: A total of 11,130 asymptomatic women underwent 27,825 screening sessions, (mammography and subsequent PE). Women with dense breasts subsequently underwent screening US. Abnormalities were deemed positive if biopsy findings revealed malignancy and negative if findings from biopsy or all screening examinations were negative. RESULTS: In 221 women, 246 cancers were found. Sensitivity, specificity, negative and positive predictive values, and accuracy of mammography were 77.6%, 98.8%, 99.8%, 35.8%, and 98.6%, respectively; those of PE, 27.6%, 99.4%, 99.4%, 28.9%, and 98.8%, respectively; and those of US, 75.3%, 96.8%, 99.7%, 20.5%, and 96.6%,...

1,591 citations

Journal ArticleDOI
TL;DR: The goal is to provide a clear picture of the individual components of the immune system and provide a strategy for individualized treatment of these components according to their Kesslerian importance.
Abstract: WITH neither the time nor the resources available to prevent, detect, or treat every disorder in every patient, which preventive, diagnostic, or therapeutic interventions should take priority? When

1,524 citations

Journal ArticleDOI
TL;DR: The goal was to critically appraise and synthesize evidence about the overall effectiveness of breast cancer screening, as well as its effectiveness among women younger than 50 years of age, and to evaluate previous meta-analyses of these trials and of screening test characteristics and studies evaluating the harms associated with false-positive test results.
Abstract: Study Selection: Eight randomized, controlled trials of mammography and 2 trials evaluating breast self-examination were included. One hundred fifty-four publications of the results of these trials, as well as selected articles about the test characteristics and harms associated with screening, were examined. Data Extraction: Predefined criteria were used to assess the quality of each study. Meta-analyses using a Bayesian randomeffects model were conducted to provide summary relative risk estimates and credible intervals (CrIs) for the effectiveness of screening with mammography in reducing death from breast cancer. Data Synthesis: For studies of fair quality or better, the summary relative risk was 0.84 (95% CrI, 0.77 to 0.91) and the number needed to screen to prevent one death from breast cancer after approximately 14 years of observation was 1224 (CrI, 665 to 2564). Among women younger than 50 years of age, the summary relative risk associated with mammography was 0.85 (CrI, 0.73 to 0.99) and the number needed to screen to prevent one death from breast cancer after 14 years of observation was 1792 (CrI, 764 to 10 540). For clinical breast examination and breast self-examination, evidence from randomized trials is inconclusive. Conclusions: In the randomized, controlled trials, mammography reduced breast cancer mortality rates among women 40 to 74 years of age. Greater absolute risk reduction was seen among older women. Because these results incorporate several rounds of screening, the actual number of mammograms needed to prevent one death from breast cancer is higher. In addition, each screening has associated risks and costs.

1,117 citations