7We assumed that use of tamoxifen

We corrected the annual numbers of deaths for coding changes that occurred in 1984 and 1993 as a result of revised interpretation of WHO rule 3 and for other procedural changes in 1993; the overall adjustment was only a few percentage points for women aged 50 74 but greater for younger and older age groups.7We assumed that use of tamoxifen, other treatment changes pandora rings, and screening would not have had any substantial impact on mortality until 1990 and that age and birth cohort effects were the major influences on mortality from 1971 to 1989.We fitted an age cohort model using five year age groups from 40 44 to 75 79 for 1971 89 using log linear Poisson modelling with the generalised linear models command in the statistical package STATA. Although we considered that an age cohort model was likely to give the best fit we also used age (alone) and age period models for comparison, according to the methods of Clayton and Shifflers.11 The age cohort model was highly significant (PFrom the mid 1980s the use of tamoxifen in women with breast cancer increased rapidly. By 1990 in the Thames regions over 90% of women aged over 50 years and over 50% below the age of 50 received tamoxifen.12 of randomised controlled trials suggest a fairly uniform effect of tamoxifen across the age range 50 79 years.13 The effect of screening, in contrast, will be more age dependent because of the age range of women invited.

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