Incidence of advanced-stage breast cancer in regular participants of a mammography screening program: a prospective register-based study

Laura Khil,Jan Heidrich,Vanessa Kääb-Sanyal,Ina Wellmann,Hans-Werner Hense,Stefanie Weigel,Walter Heindel,Oliver Heidinger

doi:10.1186/s12885-020-6646-5

Abstract

BackgroundThe European Guidelines for breast cancer screening suggest that the impact of population-based mammography screening programmes (MSP) may be assessed using the relative reduction in the incidence of advanced breast cancer (ABC, that is, stage UICC II and higher) as a surrogate indicator of screening effectiveness.MethodsThis prospective, population register-based study contained individual data of 1,200,246 women (aged 50–69 years) who attended the initial prevalence screening between 2005 and 2009. Of them, 498,029 women returned for the regular (i.e., within 24 months) first subsequent, and 208,561 for the regular second subsequent incidence screenings. The incidence rate of ABC was calculated for the 24-months period following, but not including, the initial screening by incorporating all interval ABCs and all ABCs detected at the regular first incidence screening; the ABC rate for the second 24-months period was determined in the same way, including ABCs detected in the interval after the first and, respectively, at the second incidence screening. The relative reduction in the ABC incidence was derived by comparing the age-standardized rates in these two periods with an age-standardized reference incidence rate, observed in the target population before the MSP implementation. The strengths and weaknesses of this particular study design were contrasted with a recently published checklist of main methodological problems affecting studies of the effect of MSP on ABC incidence.ResultsThe age-standardized ABC incidence rate was 291.6 per 100,000 women for the 24-months period subsequent to the initial screening, and 275.0/100,000 for the 24-months period following the first subsequent screening. Compared to the 2-year incidence of 349.4/100,000 before the start of the MSP, this amounted to a relative reduction of 16.5 and 21.3%, respectively, in the incidence of ABC among regular MSP participants.ConclusionsThe design employed in this study avoids some of the substantial methodological limitations that compromised previous observational studies. Nevertheless, specific limitations prevail that demand a cautious interpretation of the results. Therefore, the study findings, indicating a reduction in ABC for regular MSP participants, need to be followed with respect to potential impacts on breast cancer mortality rates.

Highlights

The European Guidelines for breast cancer screening suggest that the impact of population-based mammography screening programmes (MSP) may be assessed using the relative reduction in the incidence of advanced breast cancer (ABC, that is, stage UICC II and higher) as a surrogate indicator of screening effectiveness
The reduction in the incidence of advanced breast cancer (ABC) is probably the most informative surrogate indicator for the breast cancer mortality decline that may be expected from an organized mammography screening program [1,2,3]
The detection rate for invasive plus in-situ breast cancers was 831.4 per 100,000 women screened at the initial prevalence screening and 537.7 and 518.4 per 100,000, respectively, in the two subsequent incidence screenings (Table 1)

Summary

Introduction

The European Guidelines for breast cancer screening suggest that the impact of population-based mammography screening programmes (MSP) may be assessed using the relative reduction in the incidence of advanced breast cancer (ABC, that is, stage UICC II and higher) as a surrogate indicator of screening effectiveness. Numerous observational studies, investigating routine screening programs in various populations, have produced rather inconsistent findings with regard to the changes of ABC incidence observable in the course of the different programs [4,5,6,7,8,9,10,11,12,13]. The majority of these studies assessed changes of ABC incidence rates based on aggregated population data because they had no access to individual information on screening history and diagnoses. Despite large methodological differences (e.g., definition of ABC, definition of screening attender, duration of follow-up, etc.), all five studies observed reductions in the ABC incidence of screening attenders compared to non-attenders [4,5,6,7,8]

Methods

Results

Discussion

Conclusion