In Sweden, mortality trends had steadily decreased since 1972 2 and screening implementation did not lead to a new inflexion in trends after 1972.
Deficiencies in European colorectal cancer screening guideline implementation, and inadequacy of screening test advising in primary care setting were highlighted in a recent systematic review of literature, but only data from Italian and French physicians were available for the USA vs European data comparison [ 3].
Advances in treatment and implementation of screening programs decrease its incidence and mortality rates; however, the current 5-year survival rate for colorectal cancer is considered only "relatively good" (62 65%) in North America [ 1, 2].
The long time for a response reflects the fact that the screening program was undergoing implementation and that only screening radiologists read the mammogram images in order to achieve high quality.
Main outcome measure Incidence rates of early stage (I, II, or ductal carcinoma in situ) and advanced stage (III and IV) breast cancer before and after implementation of screening.
Owing to gradual implementation and a screening interval of five years only, our data do not include results from the second round.
This inference has serious implications for the implementation of screening methods and effective infection control strategies.
While not always feasible, an experimental or quasi-experimental design (e.g. randomized controlled trials, cluster randomized trials, stepped wedge, or time-series designs) should be used to compare detection rates prior to and following implementation of screening.
Age-adjusted incidence of invasive cancer increased in the first year after the implementation of screening programme, and then decreased from 57.8 in 1996 to 26.2 in 2006 (54.7% reduction).
Our study showed that the risk for cancer, gastrointestinal and breast, associated with germline LKB1/STK11 mutations is high and supports recent implementation of screening protocols suggested for patients (Wirtzfeld et al, 2001).
