17-YEAR EVALUATION OF BREAST-CANCER SCREENING - THE DOM PROJECT, THE NETHERLANDS

The DOM project is a non-randomized population-based breast cancer scr eening programme in Utrecht which started in 1974-75. The 17-year effe ct has been evaluated by a case-control study of breast cancer deaths during the period 1975-92 in women living in the city of Utrecht, born between 1911 and 1925, whose breast cancers were diagnosed after the initiation of the DOM project. Controls (three for each case) were def ined as women having the same year of birth as the case, living in the city of Utrecht at the time the case died, and having had the opportu nity of screening in the DOM project. Screening in the period 1975-92 indicated a breast cancer mortality reduction of 46% (odds ratio of 0. 54, 95% confidence interval 0.37-0.79). The strongest protective effec t was found at a screening interval of 2 years or less (mortality redu ction of 62%, odds ratio of 0.38), and for the highest number of scree ns (mortality reduction of 68%, odds ratio of 0.32 for more than four screens). Exclusion of breast cancer deaths that occurred within 1 yea r of diagnosis, to allow for 'lead-time' bias, gave an odds ratio of 0 .61, Early diagnosis of breast cancer by screening reduces breast canc er mortality in the long term. Bias due to the study design may slight ly overestimate the protective effect. A screening programme with a 2- yearly, or smaller, interval between successive screens will improve t he protection of screening.