Effect of Screening and Adjuvant Therapy on Mortality from Breast Cancer

Donald A. Berry, Ph.D., Kathleen A. Cronin, Ph.D., Sylvia K. Plevritis, Ph.D., Dennis G. Fryback, Ph.D., Lauren Clarke, M.S., Marvin Zelen, Ph.D., Jeanne S. Mandelblatt, Ph.D., Andrei Y. Yakovlev, Ph.D., J. Dik F. Habbema, Ph.D., Eric J. Feuer, Ph.D., for the Cancer Intervention and Surveillance Modeling Network (CISNET) Collaborators

ABSTRACT

Background We used modeling techniques to assess the relative and absolute contributions of screening mammography and adjuvant treatment to the reduction in breast-cancer mortality in the United States from 1975 to 2000.

Methods A consortium of investigators developed seven independent statistical models of breast-cancer incidence and mortality. All seven groups used the same sources to obtain data on the use of screening mammography, adjuvant treatment, and benefits of treatment with respect to the rate of death from breast cancer.

Results The proportion of the total reduction in the rate of death from breast cancer attributed to screening varied in the seven models from 28 to 65 percent (median, 46 percent), with adjuvant treatment contributing the rest. The variability across models in the absolute contribution of screening was larger than it was for treatment, reflecting the greater uncertainty associated with estimating the benefit of screening.

Conclusions Seven statistical models showed that both screening mammography and treatment have helped reduce the rate of death from breast cancer in the United States.