The graph (see Figure 3) speaks for itself and the method we have used is bulletproof. We can now say that early detection is the key if we want to significantly reduce mortality in the population. This is a clear and easily understandable message both for the medical community as well as for women.
You mentioned that the mortality reduction is independent of the treatment regime, can you elaborate?
Because the comparison of participating and non-participating women was contemporaneous—with mammography screening and breast cancer treatment taking place during the same period of time—it is unaffected by potential changes in treatment of breast cancer over time. We can then conclude that breast cancer screening reduces the risk of death from the disease above and beyond current therapies in the absence of screening. One could otherwise claim the decreased mortality in breast cancer is due to better treatments alone, and not improved by screening. Both are needed, and our study shows that detecting breast cancer early on is improving treatment outcomes.
A final question, do you have any recommendations to those managing screening programs?
One could express in brief that both the “providers” (healthcare personnel) and the “consumers” (women) need regular information, training, and further education about the results of modern clinical cancer research. In addition, the introduction of new imaging methods, such as preoperative breast MRI for each breast cancer patient, and of automated breast ultrasound, as an adjunctive method to full-field digital mammography, should be implemented for examining women with dense breast tissue, since we are missing every third invasive cancer hiding in the dense breast tissue. Large-section histopathology needs to replace the archaic, currently used small-section histopathology method.
I would also like to mention the results of our third article (6), published in May 2020 in the Journal of Medical Screening, in the United Kingdom. We wrote this article because the relative risk (RR) values in the article from 2020 (1) showed large variations in the different counties, giving the impression that the service to women varied significantly in the nine counties. The third article (6) clarified this issue and concluded that the physicians and the personnel in all nine counties provided the very same benefit for those women who attended screening, but the survival rates were not only significantly poorer but also varied enormously among women who did not attend screening.
These results are important since they prove that women in 30% of the country receive the same high-quality mammography service, whether it be in Stockholm, central Sweden, or the north of the country. But it also shows that breast cancer survival is significantly poorer among women who did not attend screening and that modern therapeutic regimens could not influence breast cancer the same way among women who did not attend screening compared with those who did. This variation in mortality between participating and non-participating women is illustrated by the Figures 4 and 5 below (6).
Figure 4. Survival of breast cancer patients participating in mammography screening, by county (6).
Figure 5. Survival of breast cancer patients not participating in mammography screening, by county (6).