Abstract
IntroductionMammography screening reduces breast cancer mortality through earlier diagnosis but may convey further benefit if screening is associated with optimized treatment through multidisciplinary medical care. In Norway, a national mammography screening program was introduced among women aged 50 to 69 years during 1995/6 to 2004. Also during this time, multidisciplinary breast cancer care units were implemented.MethodsWe constructed three cohorts of breast cancer patients: 1) the pre-program group comprising women diagnosed and treated before mammography screening began in their county of residence, 2) the post-program group comprising women diagnosed and treated through multidisciplinary breast cancer care units in their county but before they had been invited to mammography screening; and 3) the screening group comprising women diagnosed and treated after invitation to screening. We calculated Kaplan-Meier plots and multivariable Cox proportional hazard models.ResultsWe studied 41,833 women with breast cancer. The nine-year breast cancer-specific survival rate was 0.66 (95%CI: 0.65 to 0.67) in the pre-program group; 0.72 (95%CI: 0.70 to 0.74) in the post-program group; and 0.84 (95%CI: 0.80 to 0.88) in the screening group. In multivariable analyses, the risk of death from breast cancer was 14% lower in the post-program group than in the pre-program group (hazard ratio 0.86; (95%CI: 0.78 to 0.95, P = 0.003)).ConclusionsAfter nine years follow-up, at least 33% of the improved survival is attributable to improved breast cancer management through multidisciplinary medical care.
Highlights
Mammography screening reduces breast cancer mortality through earlier diagnosis but may convey further benefit if screening is associated with optimized treatment through multidisciplinary medical care
The risk of death from breast cancer was 14% lower in the post-program group than in the pre-program group (hazard ratio 0.86; (95%confidence interval (CI): 0.78 to 0.95, P = 0.003))
After nine years follow-up, at least 33% of the improved survival is attributable to improved breast cancer management through multidisciplinary medical care
Summary
Mammography screening reduces breast cancer mortality through earlier diagnosis but may convey further benefit if screening is associated with optimized treatment through multidisciplinary medical care. In Norway, a national mammography screening program was introduced among women aged 50 to 69 years during 1995/6 to 2004. During this time, multidisciplinary breast cancer care units were implemented. In many Western countries, breast cancer incidence is increasing, while mortality rates remain stable or are decreasing [1]. Two obvious factors have contributed to this success: widespread use of systemic adjuvant treatment [3,4,5] and earlier diagnosis due to mammography screening [6,7]. A Swedish study found about an 18% reduction in mortality due to factors other than screening [9]
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