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International Journal of Inflammation, Cancer and Integrative Therapy - Impact on Breast Cancer Mortality of Breast Cancer Screening in Case- Control Studies
ISSN: 2381-8727

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  • Mini Review   
  • Int J Inflam Cancer Integr Ther, Vol 10(3)

Impact on Breast Cancer Mortality of Breast Cancer Screening in Case- Control Studies

Marcas Pape*
Department of Epidemiology, Biostatistics and HTA, Netherlands
*Corresponding Author: Marcas Pape, Department of Epidemiology, Biostatistics and HTA, Netherlands, Email:

Received: 29-May-2023 / Manuscript No. ijm-23-98262 / Editor assigned: 01-Jun-2023 / PreQC No. ijm-23-98262(PQ) / Reviewed: 15-Jun-2023 / QC No. ijm-23-98262 / Revised: 22-Jun-2023 / Manuscript No. ijm-23-98262(R) / Published Date: 29-Jun-2023


Background: Different levels of breast cancer mortality reduction have been shown in recent case-control studies on the efficacy of population-based breast cancer screening. We looked into how the case-control research design's elements, such as the definition of cases and exposure to screening, affected these discrepancies.

Materials and procedures: We looked at six case-control studies that were carried out in South Australia, The Netherlands, Wales, Iceland, central and northern Italy, and East Anglia (UK).

Results: The difference between screened and unscreened women's breast cancer mortality decreased from 38% to 70% in several case-control studies. We observed design changes, such as whether to include or exclude the first years of screening and the self-selection bias correction factor.

Conclusions: The case-control studies' designs were generally comparable. It is highly improbable that changes in the case-control study design are to blame for the variances in the amount of breast cancer mortality reductions. These variations must be the result of additional elements, such as how the service screening programme is set up and the attendance rate. These case-control studies' estimated decrease in breast cancer mortality suggests that the impact of contemporary mammographic screening is at least consistent with the benefit noted by the previous
randomised screening trials.


Breast cancer screening; Case–control studies; Design; Breast cancer


In recent years, numerous case–control studies have attempted to estimate the impact of population-based service screening programs. The mortality rate from breast cancer has decreased, according to their findings, which are at least consistent with those of the RCTs that were conducted in the 1970s and 1980s. Nonetheless, the chances proportion (OR), which estimates the greatness of the impact, shifts essentially between the different investigations [1]. We investigated the role that different types played in the case-control strategy in relation to the differences in the evaluated effects of population-based breast cancer screening on breast cancer mortality.

To personally invite every eligible woman in the area served by a screening program to each organizational screening round is the goal of population-based screening. The program must be continuously monitored in order to better comprehend the positive and negative outcomes of screening, such as the number of false positive screening results. Additionally, periodic reevaluations of viability are required due to long-term changes in bosom disease risk, screening methods, and treatment [2].

A case–control study is an efficient method for estimating the benefits of cancer screening. Sasco and co. In 1986, suggested that a regular case–control evaluation of the operation of a mass screening program could or ought to be an essential component of ongoing evaluation. A few of the methodological difficulties associated with using a case–control study include the definition and selection of cases and controls, as well as the definition of exposure to screening and selfselection bias [3].

Driving a case-control focus on begins with portraying the source people. A source population must consist of women who have died from breast cancer (cases) and women who have not (controls), and all members of the source population must be eligible for population- based screening. Using death certificates to identify breast cancer as the primary cause of death in these instances is a reliable method. The population that was the source of the cases should be used as a source for controls [4]. Also, they shouldn't have bosom malignant growth at the hour of the case's finding and ought to in any case be alive at the hour of the case's demise. Care must be taken to ensure that both the cases and the controls will receive equal screening chances. The screening narratives of the cases and controls are differentiated after the cases and controls have been recognized. If screening is successful, cases have had less exposure to screening than controls [5].

Material and Methods

Literature search

To find recent English-language case–control studies that evaluated the effect of a breast cancer service screening programs in steady state on breast cancer mortality, a PubMed search was conducted for the years 2000 to 2010. A study was considered if it met the following criteria: We defined breast cancer deaths after the year 2000 as being included in the steady state of screening, so the case–control studies had to be based on population-based screening programs.

Design aspects of case–control studies

We focused on five design features of the selected case–control studies that may have an impact on the estimated ORs' magnitude: the definition of exposure to screening, the selection of cases and controls, the correction for potential selection bias, and the source population. On the off chance that data was not accessible in the paper, we reached the principal creator. The six case–control studies' design is shown. In a timeline, the transition from an uninvited population to an invited population (source population) following the start of a screening program is depicted. A case and control, both of whom have a history of breast cancer screening, were selected from this invited population to estimate the effectiveness of breast cancer screening [6].

Source population

We looked at differences in the age of invitation based on the source population; for instance, not all nations include women between the ages of 40 and 49. This may result in a different estimation of the screening program's impact [7]. Women between the ages of 50 and 69 may benefit less from breast cancer screening than women between the ages of 40 and 49. Counting ladies matured 40-49 years in the examination will thusly bring about an OR more like 1.

Selection of cases

A differentiation is made between essential bosom malignant growth passings (bosom disease as hidden reason for death) and optional bosom disease passings (bosom disease present at death). There is a possibility that the outcomes will differ depending on whether primary breast cancer deaths are included or not; the impact of screening may be diminished in this particular instance [8].


Between 1987 and 1990, service screening began in the six countries of the case–control studies that were found. The relevant background information for the service screening in each nation is detailed in Table 1. Table 2 shows an outline of the consequences of the investigation of ladies who went to screening contrasted and the individuals who didn't go to screening. The reduction in mortality was as low as 38% in Wales (OR 0.62, 95% CI 0.47–0.82) and as high as 70% in The Netherlands (OR 0.30, 95% CI 0.14–0.63). These outcomes incorporate no amendments for self-determination

Source population

All programmes invite women aged 50–69 years, with the exception of Wales, which invites women aged 50–64 years. The UK and Australia allow women over 70 years to come to the screening, whereas The Netherlands actively invites women aged up to 74 years. Women aged 40–49 years are actively invited in Iceland and are allowed to take part in the service screening in Australia.

Selection of cases

Four case-control concentrates on included essential bosom disease passings as it were. Allgood and Defender likewise included auxiliary bosom disease passings. The ORs determined by Allgood and Defender, 0.35 and 0.62, separately, were indistinguishable to the next four investigations. Allgood, Paap, and Roder limited the number of years after a breast cancer diagnosis and the number of years after a breast cancer death, leaving out the most common cases during the years when the screening program was in place. Out of all the case– control studies, Allgood and Paap had the lowest odds ratios [9].

Selection of controls

Five case-control concentrates on involved a pseudo determination for each control, which was equivalent to the date of conclusion of that control's matched case (Allgood, Defender, Gabe, Puliti and Roder). Puliti postponed the pseudo diagnosis for the controls matched to screen-detected cases by one year in the design phase to compensate for the lead time in the screen-detected cases in order to guarantee an equal opportunity for screening. Defender did likewise, however at that point as an optional investigation and with a deferment of year and a half. The OR was unaffected by this. Paap ensured that the control was invited to the same screening round as the case's index invitation to correct for opportunity for screening. A calculation that was described by Duffy et al. served as the foundation for the correction for opportunity in Gabe's study [10].


Our research focused on how differences in the design of recent case–control studies affected the effect of population-based breast cancer screening programs on breast cancer mortality. Despite the fact that we tracked down numerous minor distinctions in the set up of the six case-control studies, the general plan was very comparable. Be that as it may, the scope of the mortality decreases in the different case-control studies was enormous: from a decrease of 38% in Wales to a decrease of 70% in The Netherlands [11].

Only women between the ages of 40 and 49 were included in the studies conducted by Gabe and Roder due to differences in invited age groups. In his stratified analysis of the effect of different age groups, Roder found an OR of 1.18 for those under 50 and an OR of 0.54 for those between 50 and 69 [12]. The fact that the OR for the age group 50-69 years changed from 0.59 for all ages to 0.54 for the age group 50-69 years indicates that Australia's estimated OR is not significantly different from that of other nations. This may be because there are fewer cases in the 40-49 age range than in the 50-69 age range. As a result, the outcomes for the second group will make up the majority of the OR of 0.59. Gabe showed no age-explicit outcomes, however an enormous change in OR isn't normal for the relatively little numbers found in the more youthful age bunch [13-15].

All case-control studies planned to guarantee an equivalent chance for evaluating for both the controls and the cases. In the OR, Fielder did not exhibit any changes. A responsiveness examination completed by Puliti for delays of a half year and 1.5 years rather than 1 year showed just little modifications in the OR. After accounting for the opportunity for screening, Gabe's OR decreased from 0.59 (95% CI 0.41-0.84) to 0.51 (95% CI 0.31-0.86), indicating only a modest change. Gabe used a method developed by Duffy et al. as the basis for his correction. 31]. Using Duffy et al.'s correction method in the initial years of screening, will already partially adjust for the prevalent screens. Duffy et al.'s study also corrected Fielder's OR for the chance of screening using the same method, but the OR did not change. These outcomes show that the effect of chance for screening on the greatness of the OR is restricted.



Conflict of Interest



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Citation: Pape M (2023) Impact on Breast Cancer Mortality of Breast CancerScreening in Case-Control Studies. Int J Inflam Cancer Integr Ther, 10: 221.

Copyright: © 2023 Pape M. This is an open-access article distributed under theterms of the Creative Commons Attribution License, which permits unrestricteduse, distribution, and reproduction in any medium, provided the original author andsource are credited.