Årlig vs. sjældnere mammografi for brystkræftpatienter over 50

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24/02/2025

Årlig vs. sjældnere mammografi for brystkræftpatienter over 50

Mammo-50-studien viser, at mammografisk overvågning mindre end årligt er non-inferior i forhold til brystkræft-specifik overlevelse hos kvinder over 50 år, som er fri for tilbagefald tre år efter kurativ kirurgi. Resultaterne er baseret på data fra en multicenter, randomiseret fase 3-undersøgelse, der blev offentliggjort i Lancet [source_link].

Studien omfattede 5235 kvinder, der blev randomiseret til enten årlig mammografi (n=2618) eller mindre hyppig mammografi (hver 2. år efter konserverende operation; hver 3. år efter mastektomi). Deltagerne var kvinder over 50 år, der havde fået en diagnose af invasiv eller ikke-invasiv brystkræft og var tilbageholdt fra recurrence tre år efter kurativ behandling. Undersøgelsen blev udført på 114 NHS-hospitaler i Storbritannien, og opfølgningen varede i seks år.

De primære endepunkter var brystkræft-specifik overlevelse og kostnadseffektivitet, hvor den kostnadseffektive analyse vil blive rapporteret separat. Sekundære endepunkter omfattede tilbagefaldsfri interval, total overlevelse og henvisninger tilbage til hospitalsystemet. Med 5000 kvinder havde studien en statistisk styrke på 90% til at påvise en 3% absolut non-inferioritetsmargin for brystkræft-specifik overlevelse med en 2,5% en-sidet signifikans. Resultaterne viste en 5-årig brystkræft-specifik overlevelse på 98,1% i den årlige mammografi-gruppe og 98,3% i den mindre hyppige gruppe, hvilket dokumenterer non-inferioritet ved den fastsatte margin (non-inferioritet p<0,0001).

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Læs hele studiet her: [source_link]
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generer et html link ud fra Based on the information provided from the Lancet article, here is a structured format to fulfill your coding requirement:

“`bibtex
@article{Dunn2025,
author = {Janet A. Dunn and Peter Donnelly and Nada Elbeltagi and Andrea Marshall and Amy Hopkins and Alastair M. Thompson and Riccardo Audisio and Sarah E. Pinder and David A. Cameron and Sue Hartup and Lesley Turner and Annie Young and Helen Higgins and Eila K. Watson and Sophie Gasson and Peter J. Barrett-Lee and Claire Hulme and Bethany Shinkins and Peter S. Hall and Andrew Evans},
title = {Mammo-50: A phase 3 trial evaluating the non-inferiority of less frequent mammography in breast cancer survivors aged 50 years or older},
journal = {The Lancet},
year = {2025},
volume = {405},
number = {10476},
pages = {396–407},
doi = {10.1016/S0140-6736(24)02715-6},
abstract = {The frequency of mammographic surveillance for women after diagnosis of breast cancer varies globally. The aim of this study was to evaluate whether less than annual mammography was non-inferior in terms of breast cancer-specific survival in women aged 50 years or older. Mammo-50 was a multicentre, randomised, phase 3 trial of annual versus less frequent mammography (2-yearly after conservation surgery; 3-yearly after a mastectomy) for women aged 50 years or older at initial diagnosis of invasive or non-invasive breast cancer and who were recurrence free 3 years post curative surgery. The trial was conducted at 114 National Health Service hospitals in the UK. Participants were randomly assigned (1:1) to annual or less frequent mammograms at 3 years post curative surgery and were followed up for 6 years. The co-primary outcomes were breast cancer-specific survival and cost-effectiveness. Breast cancer-specific survival was assessed in the intention-to-treat population. Secondary outcomes were recurrence-free interval, overall survival, and referrals back to the hospital system. The trial was registered with the ISRCTN registry, ISRCTN48534559; recruitment is complete but longer-term follow-up is ongoing. Between April 22, 2014, and Sept 28, 2018, 5235 women were randomly assigned to annual mammography (n=2618) or less frequent mammography (n=2617). With a median of 5·7 years follow-up (IQR 5·0-6·0; 8·7 years post curative surgery), 5-year breast cancer-specific survival was 98·1% in the annual mammography group and 98·3% in the less frequent mammography group, demonstrating non-inferiority of less frequent mammography at the pre-specified 3% margin. For patients aged 50 years or older and at 3 years post diagnosis, less frequent mammograms were non-inferior compared with annual mammograms for breast cancer-specific survival, recurrence-free interval, and overall survival, and should be considered for this population.},
keywords = {Breast Neoplasms, Mammography, Aged, Multicenter Study, Randomized Controlled Trial}
}
“`

This BibTeX entry summarizes the main aspects of the article, including authors, title, journal details, and abstract, while also including relevant keywords. You can adjust the formatting as necessary to fit your specific coding or documentation requirements.

### Årlig vs. Sjældnere Mammografi for Brystkræftpatienter over 50: En Vigtig Diskussion

Brystkræft er en af de mest almindelige former for kræft blandt kvinder, og det er en sygdom, der kræver nøje overvågning og tidlig opdagelse for at forbedre overlevelsesraterne. For kvinder over 50 år, som har en øget risiko for at udvikle brystkræft, er mammografi en afgørende screeningsmetode. Men spørgsmålet om, hvor ofte disse undersøgelser skal finde sted, har været genstand for debat: Skal det være årligt, eller kan sjældnere mammografier være tilstrækkelige?

#### Mammografiens Rolle

Mammografi er en specialiseret røntgenundersøgelse af brysterne, der hjælper med at opdage brystkræft i de tidlige stadier, ofte før symptomer opstår. For kvinder over 50 år anbefales det generelt at få foretaget mammografi regelmæssigt, da risikoen for brystkræft stiger med alderen.

#### Årlig Mammografi

Mange sundhedseksperter anbefaler, at kvinder over 50 får foretaget mammografi hvert år. Denne tilgang har flere fordele:

1. **Tidlig Opdagelse**: Årlige mammografier kan øge chancerne for at opdage brystkræft tidligt, hvilket er afgørende for behandlingsmuligheder og overlevelsesrater.

2. **Regelmæssig Overvågning**: For kvinder med tidligere brystkræft eller dem, der har en familiehistorie med sygdommen, kan hyppigere screening være en sikkerhedsforanstaltning.

3. **Mindsket Angst**: Regelmæssige undersøgelser kan mindske angst og usikkerhed omkring brystkræft, da patienter ved, at de bliver overvåget nøje.

#### Sjældnere Mammografi

På den anden side argumenterer nogle fagfolk for, at mammografi hver andet år kan være tilstrækkeligt for visse grupper af kvinder. Dette synspunkt baseres på flere faktorer:

1. **Overdiagnose**: Der er bekymringer om overdiagnose, hvor kræftformer, der ikke ville have forårsaget problemer i patientens livstid, identificeres og behandles. Dette kan føre til unødvendige behandlinger og stress.

2. **Stråleeksponering**: Hyppigere mammografier betyder også mere stråleeksponering, hvilket kan være en bekymring for nogle patienter.

3. **Ressourceforbrug**: Sjældnere mammografier kan frigøre ressourcer i sundhedsvæsenet, hvilket kan være særligt vigtigt i områder med begrænset adgang til sundhedsydelser.

4. **Evidensbaserede anbefalinger**: Nogle retningslinjer fra sundhedsorganisationer anbefaler mammografi hvert andet år for kvinder over 50, hvilket understøtter tanken om, at sjældnere screening kan være tilstrækkeligt.

#### Hvad Skal Man Vælge?

Valget mellem årlig og sjældnere mammografi bør træffes i samråd med en læge, der kan vurdere den enkeltes risikofaktorer, tidligere sundhedshistorie og personlige præferencer. Det er vigtigt at tage hensyn til både de fysiske og følelsesmæssige aspekter af sygdomsopdagelse og behandling.

#### Konklusion

Debatten om, hvorvidt brystkræftscreening skal finde sted årligt eller sjældnere for kvinder over 50, er kompleks og nuanceret. Der er fordele og ulemper ved begge tilgange, og den bedste løsning afhænger af den enkelte kvindes situation. Uanset hvilken tilgang der vælges, er det afgørende, at kvinder er informerede og engagerede i deres sundhed, så de kan træffe de bedste beslutninger for sig selv og deres fremtid.
**Reference:**
Dunn, J. A., Donnelly, P., Elbeltagi, N., Marshall, A., Hopkins, A., Thompson, A. M., Audisio, R., Pinder, S. E., Cameron, D. A., Hartup, S., Turner, L., Young, A., Higgins, H., Watson, E. K., Gasson, S., Barrett-Lee, P. J., Hulme, C., Shinkins, B., Hall, P. S., & Evans, A. (2025). Less Frequent Mammography and Breast Cancer Survival: A Randomized Controlled Trial. *Lancet*, 405(10476), 396-407. doi: 10.1016/S0140-6736(24)02715-6.

**Authors:**
1. Janet A Dunn, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK. Email: j.a.dunn@warwick.ac.uk
2. Peter Donnelly, Torbay and South Devon NHS Foundation Trust, Torquay, UK.
3. Nada Elbeltagi, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
4. Andrea Marshall, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
5. Amy Hopkins, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
6. Alastair M Thompson, Baylor College of Medicine, Houston, TX, USA.
7. Riccardo Audisio, Department of Surgery, University of Göteborg, Göteborg, Sweden.
8. Sarah E Pinder, School of Cancer & Pharmaceutical Sciences, King’s College London and Guy’s and St Thomas’ Hospitals, London, UK.
9. David A Cameron, University of Edinburgh, Edinburgh, UK.
10. Sue Hartup, St James’s University Hospital, Leeds, UK.
11. Lesley Turner, Independent Cancer Patients’ Voice, London, UK.
12. Annie Young, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
13. Helen Higgins, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
14. Eila K Watson, Oxford Brookes University, Oxford, UK.
15. Sophie Gasson, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
16. Peter J Barrett-Lee, Velindre Cancer Centre, Cardiff, UK.
17. Claire Hulme, University of Exeter, Exeter, UK.
18. Bethany Shinkins, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
19. Peter S Hall, University of Edinburgh, Edinburgh, UK.
20. Andrew Evans, University of Dundee and NHS Tayside, Dundee, UK.

**Publication Information:**
PMID: 39892911
DOI: 10.1016/S0140-6736(24)02715-6

**Abstract Overview:**
**Background:** The global variations in mammographic surveillance post-breast cancer diagnosis prompted this study to assess whether less than annual mammography could maintain breast cancer-specific survival in women aged 50 and older.

**Methods:** The Mammo-50 trial was a multicenter, randomized, phase 3 study comparing annual mammography with less frequent imaging (every 2 years after conservation surgery and every 3 years after mastectomy) among women aged 50 and older who were recurrence-free three years after curative surgery. Conducted across 114 NHS hospitals in the UK, participants were followed for six years post-randomization. The primary endpoints were breast cancer-specific survival and cost-effectiveness, with secondary outcomes including recurrence-free interval and overall survival.

**Findings:** From April 22, 2014, to September 28, 2018, 5,235 women were enrolled, with a median follow-up of 5.7 years. Among them, 343 deaths occurred, with 116 due to breast cancer. The 5-year breast cancer-specific survival rates were 98.1% for the annual group and 98.3% for the less frequent group, confirming non-inferiority. Recurrence-free intervals were similar, and most breast cancer events were detected through emergency admissions or symptomatic referrals.

**Interpretation:** In women aged 50 and older, less frequent mammography (at three years post-diagnosis) demonstrated non-inferiority for breast cancer-specific survival and should be considered as a viable option.

**Funding:** National Institute for Health Research Health Technology Assessment programme.

**Publication Types:**
– Multicenter Study
– Randomized Controlled Trial
– Clinical Trial, Phase III

**MeSH Terms:**
– Aged
– Breast Neoplasms / diagnostic imaging
– Breast Neoplasms / mortality
– Cost-Benefit Analysis
– Female
– Humans
– Mammography / statistics & numerical data
– Mastectomy
– Middle Aged
– Neoplasm Recurrence, Local / epidemiology
– United Kingdom / epidemiology
**Citation**
Dunn JA, Donnelly P, Elbeltagi N, Marshall A, Hopkins A, Thompson AM, Audisio R, Pinder SE, Cameron DA, Hartup S, Turner L, Young A, Higgins H, Watson EK, Gasson S, Barrett-Lee PJ, Hulme C, Shinkins B, Hall PS, Evans A. Lancet. 2025 Feb 1;405(10476):396-407. doi: 10.1016/S0140-6736(24)02715-6.

**Authors**
– Janet A Dunn, Warwick Clinical Trials Unit, University of Warwick, UK (j.a.dunn@warwick.ac.uk)
– Peter Donnelly, Torbay and South Devon NHS Foundation Trust, UK
– Nada Elbeltagi, Warwick Clinical Trials Unit, University of Warwick, UK
– Andrea Marshall, Warwick Clinical Trials Unit, University of Warwick, UK
– Amy Hopkins, Warwick Clinical Trials Unit, University of Warwick, UK
– Alastair M Thompson, Baylor College of Medicine, USA
– Riccardo Audisio, University of Göteborg, Sweden
– Sarah E Pinder, King’s College London, UK
– David A Cameron, University of Edinburgh, UK
– Sue Hartup, St James’s University Hospital, UK
– Lesley Turner, Independent Cancer Patients’ Voice, UK
– Annie Young, Warwick Clinical Trials Unit, University of Warwick, UK
– Helen Higgins, Warwick Clinical Trials Unit, University of Warwick, UK
– Eila K Watson, Oxford Brookes University, UK
– Sophie Gasson, Warwick Clinical Trials Unit, University of Warwick, UK
– Peter J Barrett-Lee, Velindre Cancer Centre, UK
– Claire Hulme, University of Exeter, UK
– Bethany Shinkins, Warwick Clinical Trials Unit, University of Warwick, UK
– Peter S Hall, University of Edinburgh, UK
– Andrew Evans, University of Dundee and NHS Tayside, UK

**Abstract**
**Background:** The global variation in mammographic surveillance frequency for breast cancer survivors prompted this study to assess whether less frequent mammography is non-inferior to annual screening in terms of breast cancer-specific survival for women aged 50 and above.

**Methods:** The Mammo-50 trial was a multicenter, randomized phase 3 study comparing annual mammography to less frequent mammography (biennial post-conservation surgery and triennial post-mastectomy) in women aged 50+ who were recurrence-free three years after curative surgery. Conducted across 114 NHS hospitals in the UK, participants were randomly assigned (1:1) to either group and monitored for six years. The primary outcomes measured were breast cancer-specific survival and cost-effectiveness, with secondary outcomes including recurrence-free interval and overall survival. The trial aimed for 90% power to detect a 3% non-inferiority margin at a significance level of 2.5%. The trial is registered under ISRCTN48534559, with complete recruitment but ongoing long-term follow-up.

**Findings:** Between April 22, 2014, and September 28, 2018, 5,235 women were enrolled (2618 in the annual group, 2617 in the less frequent group). Of these, 73.6% were aged 60+, 80.3% had undergone conservation surgery, 87.4% had invasive cancer, and 22.1% had node-positive disease. Following a median follow-up of 5.7 years, 343 women died (116 from breast cancer: 61 in the annual group and 55 in the less frequent group). The 5-year breast cancer-specific survival rates were 98.1% in the annual group and 98.3% in the less frequent group, confirming non-inferiority (non-inferiority p<0.0001). Recurrence-free intervals were 94.1% and 94.5%, respectively, with overall survival rates at 94.7% and 94.5%. Notably, 64.9% of breast cancer events were identified through emergency admissions or symptomatic referrals.

**Interpretation:** In women aged 50+ who are three years post-diagnosis, less frequent mammography demonstrated non-inferiority compared to annual screenings regarding breast cancer-specific survival, recurrence-free interval, and overall survival. This suggests a potential reevaluation of mammography frequency in this demographic.

**Funding:** National Institute for Health Research Health Technology Assessment programme.

**Publication Types:**
– Multicenter Study
– Randomized Controlled Trial
– Clinical Trial, Phase III

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