Abstract
PurposeAssociations between population-based screening, breast carcinoma detection modes and breast carcinoma death have not been studied using nationwide data at individual level. We evaluated these in Finland, where invitational age is gradually expanding from 50–59 to 50–69 years in 2008–2017. We also predicted breast carcinoma patterns in 2020 to assess the impact of changing invitational policy on breast carcinoma incidence and mortality.MethodsThe data included breast carcinomas in 2000–2010 (n = 48 040), and deaths due to these carcinomas (n = 4722). We divided carcinomas into those detected before or after the screening age, and those detected at the screening age. The latter was further divided into screen-detected and interval carcinomas, and carcinomas in the non-attendees. The prediction of future patterns was based on incidence data from the ten-year period 1998–2007 preceding the period of expanding invitational age in the national programme.ResultsApproximately 13% of in situ carcinomas were detected before, 29% after, and 57% at the screening age. In invasive cancers, the percentages were 16%, 42%, and 42%, respectively. At the screening age, more than half of invasive cancers were screening-detected, one quarter interval cancers, and one out of six cancers in the non-attendees. Almost 60% of breast cancer deaths were due to cancers detected after the screening age. By 2020, breast cancers detected at the screening age will increase from 42% to 65%, and breast cancers detected by screening from 23% to 38%.ConclusionsThe study demonstrates a novel approach to examine associations between breast carcinoma incidence and mortality within and outside population-based screening. The results show mammography screening having a distinct role in overall breast carcinoma incidence and mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-3-348) contains supplementary material, which is available to authorized users.
Highlights
Population-based mammography screening is a multistep process starting with identification and invitation of the target population, and continuing further to mammography test, and prospective recall examinations, cancer management and care (Vainio and Bianchini 2002; Perry et al 2008)
Most breast carcinomas were detected in ages 50–69 years (Table 1)
Few cases in age groups less than 50 and over 69 years were detected in Turku city, where the age groups 40–49 and 70–74 years had been invited to population-based screening irregularly in 2000–2007
Summary
Population-based mammography screening is a multistep process starting with identification and invitation of the target population, and continuing further to mammography test, and prospective recall examinations, cancer management and care (Vainio and Bianchini 2002; Perry et al 2008). In the screening target population, breast cancers are detected among attendees within the screening programme, or outside the programme either among non-attendees or among attendees without findings in their previous screening episode. Monitoring of the European population-based mammography screening has shown significant variation between programmes and centres in invitational coverage, attendance, and sensitivity and specificity of screening (Sarkeala et al 2004; Giordano et al 2012; Hofvind et al 2012). Variation in the screening performance (Sarkeala et al 2006; Törnberg et al 2010) – as well as in the coverage of screening – affects the ratio of breast carcinomas detected within and outside the organised screening. A considerable percentage of breast carcinomas detected outside screening may be asymptomatic with a prognostic profile comparable to that of the screendetected carcinomas (Sarkeala et al 2004; 2006; Hoff et al 2012). It is important to assess the detection of breast carcinomas in the whole female population
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