The frequency of breast cancer screening

results from the UKCCCR Randomised Trial


      The optimal frequency of breast cancer screening has been a subject of debate since the inception of the UK National Breast Screening Programme (NHSBSP). This paper reports on the only randomised trial directly comparing different screening intervals. 99 389 women aged 50–62 years who had been invited to a prevalent screen were randomly allocated after the scheduled prevalent screen date to the study arm (invited to three further annual screens), or to the control arm (invited to the standard single screen 3 years later). 37 530 women in the study arm and 38 492 in the control arm had attended the prevalent screen. The endpoint was predicted breast cancer deaths. The prediction was based on both the Nottingham Prognostic Index (NPI) and a similar method derived from survival data from a series of tumours in the Swedish Two-County screening trial (2CS). Both indices were based on the size, lymph node status and histological grade of the invasive tumours diagnosed in the two arms of the trial. The pathology of the cases diagnosed was subject to review by two pathologists using standard criteria. The tumours diagnosed in the study arm were significantly smaller than those diagnosed in the control arm (P=0.05). The relative risk of death from breast cancer for the annual compared with the 3-yearly group was 0.95 (95% Confidence Interval (CI): 0.83–1.07, P=0.4) using the NPI and 0.89 (95% CI: 0.77–1.03, P=0.09) using the 2CS. Shortening of the screening interval in this age group is predicted to have a relatively small effect on breast cancer mortality. Improvements to the screening programme would be targeted more productively on areas other than the screening interval, such as improving the screening quality.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Day N.E
        • Duffy S.W
        Trial design based on surrogate end points-application to comparison of different breast screening frequencies.
        J. R. Stat. Soc. A. 1996; 159: 49-60
        • Prentice R.L
        Surrogate endpoints in clinical trials.
        Stat. Med. 1989; 8: 431-440
        • Begg C.B
        • Leung D.H.Y
        On the use of surrogate end points in randomized trials.
        J. R. Stat. Soc. A. 2000; 163: 15-28
        • Blamey R.W
        The design and clinical use of the Nottingham Prognostic Index in breast cancer.
        The Breast. 1996; 5: 156-157
        • Todd J.H
        • Dowle C
        • Williams M.R
        • et al.
        Confirmation of a prognostic index in primary breast cancer.
        Br. J. Cancer. 1987; 56: 489-492
        • Balslev I
        • Axelsson C.K
        • Zedeler K
        • Rasmussen B.B
        • Carstensen B
        • Mouridsen H.T
        The Nottingham Prognostic Index applied to 9,149 patients from the studies of the Danish Breast Cancer Cooperative Group (DBCG).
        Breast Cancer Res. Treat. 1994; 32: 281-290
        • Organizing Committee and Collaborators
        Falun meeting. Breast cancer screening with mammography in women aged 40–49 years.
        Int. J. Cancer. 1996; 68: 693-699
        • Elston C.W
        • Ellis I.O
        Pathological prognostic factors in breast cancer. I.
        Histopathology. 1991; 19: 403-410
        • Tabar L
        • Fagerberg G
        • Chen H.H
        • et al.
        Efficacy of breast cancer screening by age.
        Cancer. 1995; 75: 2507-2517
        • Chen H.H
        • Duffy S.W
        • Tabar L
        • Day N.E
        Markov chain models for progression of breast cancer, part I.
        J. Epidemiol. Biostat. 1997; 2: 25-35
        • Boer R
        • de Koning H
        • Threlfall A
        • et al.
        Cost effectiveness of shortening screening interval or extending age range of NHS breast screening programme.
        Br. Med. J. 1998; 317: 376-379
        • Johnston K
        • Gerard K
        • Morton A
        • Brown J
        NHS Costs for the Breast Screening Frequency and Age Trials. Health Economics Research Group Discussion paper number 16.
        Brunel University, Uxbridge1996
        • Begg C
        • Cho M
        • Eastwood S
        • et al.
        Improving the quality of reporting of randomised controlled trials.
        JAMA. 1996; 276: 637-639