The Radiological Society of North America (RSNA) has just announced that the Alexander Margulis Award for Scientific Excellence in 2021 has been won by Stephen Duffy from the UK and László Tabár from Sweden. The award recognises the best original article published each year in Radiology, the RSNA’s flagship journal. Duffy (left) and Tabár (right) published their paper, which is freely available (click here), entitled “Beneficial effect of consecutive screening mammography examinations on mortality from breast cancer: a prospective study.” They will receive the award at a luncheon on 29 November 2021 when the RSNA holds its annual meeting in Chicago.
The source of the data was a 25-year study – from 1992 to 2016 – of 549,091 Swedish women who were aged 40 to 69 and eligible for screening mammography. Participation was linked with data from registries and regional cancer centres for breast cancer diagnosis, use, and date of death. “Breast cancer mortality was calculated by whether the women had participated in the most recent examination prior to diagnosis only (intermittent participants), the penultimate screening examination only (lapsed participants), both examinations (serial participants), or neither examination (serial nonparticipants).”
The research team identified 3,995 breast cancer deaths during the observation period – 7.3 per 1,000 women invited for screening – while a total of 2,589 cancers proved fatal within 10 years. The graph at left (© RSNA) shows the cumulative mortality from breast cancer per 100,000 person-years according to participation status. The data are clear: serial participants experienced the lowest cumulative mortality as follow-up increased, while serial nonparticipants fared worst.
The graph below right (© RSNA) illustrates the cumulative incidence of breast cancers that were fatal within 10 years of diagnosis per 100,000 person-years from 1992 to 2007 according to participation status. Again, the data are clear cut: serial participants experienced the lowest cumulative incidence of fatal breast cancer within 10 years of diagnosis as follow-up increased. Importantly, serial participants had a 49% lower risk of breast cancer mortality and a 50% lower risk of death from breast cancer within 10 years of diagnosis compared to serial nonparticipants.
In conclusion, regular participation in a screening mammography programme will lead to a significant reduction of dying from breast cancer. In fact, missing just a single screening examination will confer a statistically significant increase in risk. The authors concluded: “This is an important message for women in the screening age groups, their referring physicians, and public health decision makers.” The benefits of screening have been recognised by Duffy and Tabár, as well as the RSNA.
Good to see the advantage in terms of breast cancer mortality but the more critical outcome would be overall survival. How does that look?
Thanks for this feedback, Gary. The authors did not address overall survival in this particular study but they did reference other research papers:
“women with symptomatic breast cancers who have recently participated in screening show a survival advantage over women with breast cancer who did not participate in screening”
“observed better survival in symptomatic tumors in lapsed attenders (women whose most recent screening examination yielded negative results and was more than 3 years ago) than in women who never attended screening”.