Discontinuation of adjuvant hormone therapy among breast cancer patients not previously attending mammography screening

Wei He,Kamila Czene,Fredrik Strand,Louise Eriksson,Sven Törnberg,Per Hall

doi:10.1186/s12916-019-1252-6

Abstract

BackgroundBreast cancer patients who have not previously attended mammography screening may be more likely to discontinue adjuvant hormone therapy and therefore have a worse disease prognosis.MethodsWe conducted a population-based cohort study using data from Stockholm Mammography Screening Program, Stockholm-Gotland Breast Cancer Register, Swedish Prescribed Drug Register, and Swedish Cause of Death Register. Women in Stockholm who were diagnosed with breast cancer between 2001 and 2008 were followed until December 31, 2015. Non-participants of mammography screening were defined as women who, prior to their breast cancer diagnosis, were invited for mammography screening but did not attend.ResultsOf the 5098 eligible breast cancer patients, 4156 were defined as screening participants and 942 as non-participants. Compared with mammography screening participants, non-participants were more likely to discontinue adjuvant hormone therapy, with an adjusted hazard ratio (HR) of 1.30 (95% CIs, 1.11 to 1.53). Breast cancer patients not participating in mammography screening were also more likely to have worse disease-free survival, even after adjusting for tumor characteristics and other covariates (adjusted HR 1.22 (95% CIs, 1.05 to 1.42 for a breast cancer event).ConclusionsTargeted interventions to prevent discontinuation of adjuvant hormone therapy are needed to improve breast cancer outcomes among women not attending mammography screening.

Highlights

Breast cancer patients who have not previously attended mammography screening may be more likely to discontinue adjuvant hormone therapy and have a worse disease prognosis
We identified 5855 women in Stockholm who were diagnosed with breast cancer between 2001 and 2008 and who were invited to a mammography screening 2 years before their breast cancer diagnosis
Further adjustment for other covariates did not change these estimates, with an adjusted hazard ratio (HR) of 1.30 for non-participants versus screening participants (Table 2)

Summary

Introduction

Breast cancer patients who have not previously attended mammography screening may be more likely to discontinue adjuvant hormone therapy and have a worse disease prognosis. Mammography screening, which is shown to lower the risk of breast cancer mortality by over 20% [3,4,5], is one of the most important steps that women can take to reduce breast cancer mortality. Despite such demonstrated benefit, 25–42% of women do not participate in mammography screening programs [6,7,8,9]. Discontinuation of adjuvant hormone therapy reduces treatment efficacy [14,15,16,17,18], resulting in increased cancer recurrence and mortality, which could otherwise be prevented

Methods

Results

Discussion

Conclusion