Reduced breast cancer mortality after 20+years of follow-up in the Swedish randomized controlled mammography trials in Malmo, Stockholm, and Goteborg

Objective: To analyze the age- and trial-specific effects of the breast cancer screening trials with mammography in Malmo , Stockholm, and Goteborg. Methods: The original trial files were linked to the Swedish Cancer and Cause of Death Registers to obtain date of breast cancer diagnosis and date and cause of death. Relative risks and 95% confidence intervals were calculated using the evaluation model (only breast cancers diagnosed between date of randomization and date when the first screening round of the control group was completed were included in the analysis). Results: Women aged 40-70 at randomization in the Malmo I and II, Stockholm, and Goteborg trials were followed-up for an average of 30, 22, 25, and 24 years, respectively. The overview of all trials resulted in a significant decrease of 15% in breast cancer mortality. The variation by consecutive 10-year age group at randomization was small-from 21% in the age group 40-49 to 11% in the age group 50-59. After adjustment for age, there was a significant reduction in breast cancer mortality in the Goteborg trial (26%), and a non-significant reduction in the Malmo I and II and Stockholm trials (12%, 15%, and 5.8%, respectively). Conclusions: The overview showed a 15% significant relative reduction in breast cancer mortality due to invitation to mammography screening. Heterogeneity in age, trial time, attendance rates, and length of screening intervals may have contributed to the variation in effect between the trials.