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Observational study
Both a stage shift and changes in stage-specific survival have contributed to reductions in breast cancer mortality
  1. Stephen W Duffy1,
  2. Ruth Etzioni2,
  3. Peter Sasieni1
  1. 1Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
  2. 2Fred Hutchinson Cancer Research Centre, Seattle, Washington, USA
  1. Correspondence to : Professor Stephen W Duffy, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; s.w.duffy{at}qmul.ac.uk

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Context

Since randomised trials demonstrated a reduction in breast cancer mortality with mammographic screening, such screening has become widespread in developed countries, and mortality from breast cancer has declined in recent decades.1 There is interest in quantifying the proportion of this mortality reduction attributable to screening and that attributable to improvements in treatment.

Methods

This paper reported on analysis of breast cancer incidence and case death in women aged 40 years and over in the USA by tumour size. The authors compared prescreening results (1975–1979) with postscreening (2008–2012 for size distribution, 2000–2002 for 10-year case death). They used a similar approach to Duffy et al2 positing that reductions in …

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