Screening is associated with lower mastectomy rates in eastern Switzerland beyond stage effects

Christian Herrmann,Mohsen Mousavi,Beat Thürlimann,Esther Walser,Rudolf Morant

doi:10.1186/s12885-021-07917-2

Christian Herrmann, Mohsen Mousavi + Show 3 more

Open Access

https://doi.org/10.1186/s12885-021-07917-2

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Abstract

BackgroundA recent study found an influence of organized mammography screening programmes (MSPs) on geographical and temporal variation of mastectomy rates. We aimed to quantify the effect on the example of one of the cantonal programmes in Switzerland.MethodsWe used incidence data for the years 2010–2017 from the cancer registry of Eastern Switzerland. We included women with invasive-non-metastatic breast cancer (BC) in the screening age group 50–69-year-olds in the canton of St.Gallen. We compared mastectomy rates among cancer patients detected through the organised screening programme (MSP) vs. otherwise detected by stage.ResultsMSP-detected patients in St.Gallen presented with lower stages. 95% of MSP-detected had stages I-II vs 76% of Non-MSP-detected. Within all non-metastatic stage, tumour size and nodal status groups, MSP-detected patients had lower mastectomy rates, overall 10% vs 24% in 50–69-year-old non-participants. Their odds of receiving a mastectomy are about half of the Non-MSP-detected (OR = 0.48, p = 0.002).ConclusionsOur study showed that MSPs have a positive effect on lowering mastectomy rates. Screening participants are significantly less likely to receive a mastectomy compared to non-participants, which must be attributed to additional factors than just lower stages. Lower mastectomy rates lead to a higher quality of life for many patients.

Highlights

A recent study found an influence of organized mammography screening programmes (MSPs) on geographical and temporal variation of mastectomy rates
Whether the lower rate of mastectomies for cantons with existing mammography screening programmes is due to the stage shift
When stratifying by stage, tumour size or nodal status, MSP-detected patients had lower mastectomy rates throughout. (Table 1, Fig. 2) Not all differences in mastectomy rates were significant when considering Bonferroni corrections for mastectomy are less than half in MSP-detected patients (OR = 0.48, p = 0.002)

Summary

Introduction

A recent study found an influence of organized mammography screening programmes (MSPs) on geographical and temporal variation of mastectomy rates. In a recent study [11], we showed that mastectomy rates declined for patients in Switzerland aged 50–69 and 70+ and remained stable for those under 50, all with important geographical differences. When including the existence of population-based mammography screening programmes in our model, we showed an additional significantly reduced rate of mastectomies of about 13%. Population-based mammography screening programmes (MSPs) started at very different time points in Switzerland. Ess et al showed that breast cancer patients with lower stages had a significantly lower rate of mastectomies in Switzerland [6]

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