Conclusions for mammography screening after 25-year follow-up of the Canadian National Breast Cancer Screening Study (CNBSS)
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- 作者：S. H. Heywang-Köbrunner ; I. Schreer ; A. Hacker ; M. R. Noftz…
- 关键词：Breast cancer ; Mammography screening ; Canadian National Breast Cancer Screening Study (CNBSS) ; Randomization ; Image quality
- 刊名：European Radiology
- 出版年：2016
- 出版时间：February 2016
- 年：2016
- 卷：26
- 期：2
- 页码：342-350
- 全文大小：371 KB
- 刊物类别：Medicine
- 刊物主题：Medicine & Public Health
Imaging and Radiology
Diagnostic Radiology
Interventional Radiology
Neuroradiology
Ultrasound
Internal Medicine - 出版者：Springer Berlin / Heidelberg
- ISSN：1432-1084
文摘
Twenty-five-year follow-up data of the Canadian National Breast Cancer Screening Study (CNBSS) indicated no mortality reduction. What conclusions should be drawn? After conducting a systematic literature search and narrative analysis, we wish to recapitulate important details of this study, which may have been neglected: Sixty-eight percent of all included cancers were palpable, a situation that does not allow testing the value of early detection. Randomisation was performed at the sites after palpation, while blinding was not guaranteed. In the first round, this “randomisation" assigned 19/24 late stage cancers to the mammography group and only five to the control group, supporting the suspicion of severe errors in the randomisation process. The responsible physicist rated mammography quality as “far below state of the art of that time". Radiological advisors resigned during the study due to unacceptable image quality, training, and medical quality assurance. Each described problem may strongly influence the results between study and control groups. Twenty-five years of follow-up cannot heal these fundamental problems. This study is inappropriate for evidence-based conclusions. The technology and quality assurance of the diagnostic chain is shown to be contrary to today's screening programmes, and the results of the CNBSS are not applicable to them.