TY - JOUR
T1 - Evaluation issues in the swedish two-county trial of breast cancer screening
T2 - An historical review
AU - Tabar, Laszlo
AU - Chen, Tony Hsiu Hsi
AU - Hsu, Chen Yang
AU - Wu, Wendy Yi Ying
AU - Yen, Amy Ming Fang
AU - Chen, Sam Li Sheng
AU - Chiu, Sherry Yueh Hsia
AU - Fann, Jean Ching Yuan
AU - Beckmann, Kerri
AU - Smith, Robert A.
AU - Duffy, Stephen W.
N1 - Publisher Copyright:
© The Author(s) 2016.
PY - 2017/3
Y1 - 2017/3
N2 - Objectives: To summarize debate and research in the Swedish Two-County Trial of mammographic screening on key issues of trial design, endpoint evaluation, and overdiagnosis, and from these to infer promising directions for the future. Methods: A cluster-randomized controlled trial of the offer of breast cancer screening in Sweden, with a single screen of the control group at the end of the screening phase forms the setting for a historical review of investigations and debate on issues of design, analysis, and interpretation of results of the trial. Results: There has been considerable commentary on the closure screen of the control group, ascertainment of cause of death, and cluster randomization. The issues raised were researched in detail and the main questions answered in publications between 1989 and 2003. Overdiagnosis issues still remain, but methods of estimation taking full account of lead time and of non-screening influences on incidence (taking place mainly before 2005) suggest that it is a minor phenomenon. Conclusion: Despite resolution of issues relating to this trial in peer-reviewed publications dating from years, or even decades ago, issues that already have been addressed continue to be raised. We suggest that it would be more profitable to concentrate efforts on current research issues in breast cancer diagnosis, treatment, and prevention.
AB - Objectives: To summarize debate and research in the Swedish Two-County Trial of mammographic screening on key issues of trial design, endpoint evaluation, and overdiagnosis, and from these to infer promising directions for the future. Methods: A cluster-randomized controlled trial of the offer of breast cancer screening in Sweden, with a single screen of the control group at the end of the screening phase forms the setting for a historical review of investigations and debate on issues of design, analysis, and interpretation of results of the trial. Results: There has been considerable commentary on the closure screen of the control group, ascertainment of cause of death, and cluster randomization. The issues raised were researched in detail and the main questions answered in publications between 1989 and 2003. Overdiagnosis issues still remain, but methods of estimation taking full account of lead time and of non-screening influences on incidence (taking place mainly before 2005) suggest that it is a minor phenomenon. Conclusion: Despite resolution of issues relating to this trial in peer-reviewed publications dating from years, or even decades ago, issues that already have been addressed continue to be raised. We suggest that it would be more profitable to concentrate efforts on current research issues in breast cancer diagnosis, treatment, and prevention.
KW - Breast cancer screening
KW - Mammography
KW - Randomised trial
UR - http://www.scopus.com/inward/record.url?scp=85016230328&partnerID=8YFLogxK
U2 - 10.1177/0969141316631375
DO - 10.1177/0969141316631375
M3 - 文献综述
C2 - 27098311
AN - SCOPUS:85016230328
SN - 0969-1413
VL - 24
SP - 27
EP - 33
JO - Journal of Medical Screening
JF - Journal of Medical Screening
IS - 1
ER -
