scholarly journals Breast cancer mortality and overdiagnosis after implementation of population-based screening in Denmark

2020 ◽  
Vol 184 (3) ◽  
pp. 891-899
Author(s):  
Elsebeth Lynge ◽  
Anna-Belle Beau ◽  
My von Euler-Chelpin ◽  
George Napolitano ◽  
Sisse Njor ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Incidence ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
Historical Control Group ◽  
Historical Control ◽  
Control Group ◽  
Study Group ◽  
Screening Programs

Abstract Introduction Service breast cancer screening is difficult to evaluate because there is no unscreened control group. Due to a natural experiment, where 20% of women were offered screening in two regions up to 17 years before other women, Denmark is in a unique position. We utilized this opportunity to assess outcome of service screening. Materials and methods Screening was offered in Copenhagen from 1991 and Funen from 1993 to women aged 50–69 years. We used difference-in-differences methodology with a study group offered screening; a historical control group; a regional control group; and a regional–historical control group, comparing breast cancer mortality and incidence, including ductal carcinoma in situ, between study and historical control group adjusted for changes in other regions, and calculating ratios of rate ratios (RRR) with 95% confidence intervals (CI). Data came from Central Population Register; mammography screening databases; Cause of Death Register; and Danish Cancer Register. Results For breast cancer mortality, the study group accumulated 1,551,465 person-years and 911 deaths. Long-term breast cancer mortality in Copenhagen was 20% below expected in absence of screening; RRR 0.80 (95% CI 0.71–0.90), and in Funen 22% below; RRR 0.78 (95% CI 0.68–0.89). Combined, cumulative breast cancer incidence in women followed 8+ years post-screening was 2.3% above expected in absence of screening; RRR 1.023 (95% CI 0.97–1.08). Discussion Benefit-to-harm ratio of the two Danish screening programs was 2.6 saved breast cancer deaths per overdiagnosed case. Screening can affect only breast cancers diagnosed in screening age. Due to high breast cancer incidence after age 70, only one-third of breast cancer deaths after age 50 could potentially be affected by screening. Increasing upper age limit could be considered, but might affect benefit-to-harm ratio negatively.

Estrogen plus progestin (E+P) and breast cancer incidence and mortality.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1501-1501
Author(s):  
Rowan T. Chlebowski ◽  
Garnet L Anderson ◽  
Lewis H Kuller ◽  
Aaron K Aragaki ◽  
JoAnn E Manson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Cancer Incidence ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
Cancer Prognosis ◽  
Breast Cancers ◽  
Incidence And Mortality ◽  
Mortality Table

1501 Background: In the WHI clinical trial, E+P increased both breast cancer incidence and breast cancer mortality (JAMA 2010;304:1684). In contrast, breast cancers associated with E+P use in most observational studies have a more favorable prognosis. To address differences, a cohort of WHI Observational Study participants with characteristics similar to the WHI clinical trial was identified to examine E+P association with invasive breast cancer incidence and outcome. Methods: 41,449 postmenopausal women with no prior hysterectomy and mammogram negative for breast cancer < 2 years before who either were not hormone users (25,328) or were using E+P (16,121) were identified. Breast cancers were verified by centralized medical record review. Adjusted Cox proportional hazard regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CI). Additional analyses adjusted for breast cancer screening, censoring participants for incidence analyses who had a > 2 year interval without a mammogram. Results: After a mean (SD) follow-up 11.3 (3.1) years, 2,236 breast cancers were diagnosed. Breast cancer incidence was higher in E+P users (0.60% vs 0.42%, annualized rate, respectively: HR 1.55, 95% CI 1.41-1.70, P<0.001). Screening adjusted analyses had stronger breast cancer association (0.63% vs 0.39%, HR 1.72, 95% CI 1.54-1.93; P<0.001). Survival following breast cancer, measured from diagnosis date, was similar in E+P users and non-users (HR 0.95, 95% CI 0.74-1.23). Breast cancer mortality, analyzed from cohort entry date, are shown in the table. Conclusions: E+P use is associated with increased breast cancer incidence. As breast cancer prognosis following diagnosis on E+P is similar to that of nonusers, the higher incidence with E+P leads to increased breast cancer mortality. [Table: see text]

scholarly journals Geographical and socioeconomic inequalities in female breast cancer incidence and mortality in Iran: A Bayesian spatial analysis of registry data

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248723
Author(s):  
Shadi Rahimzadeh ◽  
Beata Burczynska ◽  
Alireza Ahmadvand ◽  
Ali Sheidaei ◽  
Sara Khademioureh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Mortality Rate ◽  
Cancer Incidence ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
National Level ◽  
Mortality Rates ◽  
Incidence And Mortality ◽  
Over Time

Background In Iran, trends in breast cancer incidence and mortality have generally been monitored at national level. The purpose of this study is to examine province-level disparities in age-standardised breast cancer incidence versus mortality from 2000 to 2010 and their association with socioeconomic status. Methods In this study, data from Iran’s national cancer and death registry systems, and covariates from census and household expenditure surveys were used. We estimated the age-standardised incidence and mortality rates in women aged more than 30 years for all 31 provinces in the consecutive time intervals 2000–2003, 2004–2007 and 2008–2010 using a Bayesian spatial model. Results Mean age-standardised breast cancer incidence across provinces increased over time from 15.0 per 100,000 people (95% credible interval 12.0,18.3) in 2000–2003 to 39.6 (34.5,45.1) in 2008–2010. The mean breast cancer mortality rate declined from 10.9 (8.3,13.8) to 9.9 (7.5,12.5) deaths per 100,000 people in the same period. When grouped by wealth index quintiles, provinces in the highest quintile had higher levels of incidence and mortality. In the wealthiest quintile, reductions in mortality over time were larger than those observed among provinces in the poorest quintile. Relative breast cancer mortality decreased by 16.7% in the highest quintile compared to 10.8% in the lowest quintile. Conclusions Breast cancer incidence has increased over time, with lower incidence in the poorest provinces likely driven by underdiagnoses or late-stage diagnosis. Although the reported mortality rate is still higher in wealthier provinces, the larger decline over time in these provinces indicates a possible future reversal, with the most deprived provinces having higher mortality rates. Ongoing analysis of incidence and mortality at sub-national level is crucial in addressing inequalities in healthcare systems and public health both in Iran and elsewhere.

scholarly journals Comparing CISNET Breast Cancer Incidence and Mortality Predictions to Observed Clinical Trial Results of Mammography Screening from Ages 40 to 49

2018 ◽  
Vol 38 (1_suppl) ◽  
pp. 140S-150S ◽  
Author(s):  
Jeroen J. van den Broek ◽  
Nicolien T. van Ravesteyn ◽  
Jeanne S. Mandelblatt ◽  
Hui Huang ◽  
Mehmet Ali Ergun ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Incidence ◽  
Cancer Mortality ◽  
Mammography Screening ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
Mortality Reduction ◽  
Incidence And Mortality ◽  
The Uk

Background. The UK Age trial compared annual mammography screening of women ages 40 to 49 years with no screening and found a statistically significant breast cancer mortality reduction at the 10-year follow-up but not at the 17-year follow-up. The objective of this study was to compare the observed Age trial results with the Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer model predicted results. Methods. Five established CISNET breast cancer models used data on population demographics, screening attendance, and mammography performance from the Age trial together with extant natural history parameters to project breast cancer incidence and mortality in the control and intervention arm of the trial. Results. The models closely reproduced the effect of annual screening from ages 40 to 49 years on breast cancer incidence. Restricted to breast cancer deaths originating from cancers diagnosed during the intervention phase, the models estimated an average 15% (range across models, 13% to 17%) breast cancer mortality reduction at the 10-year follow-up compared with 25% (95% CI, 3% to 42%) observed in the trial. At the 17-year follow-up, the models predicted 13% (range, 10% to 17%) reduction in breast cancer mortality compared with the non-significant 12% (95% CI, -4% to 26%) in the trial. Conclusions. The models underestimated the effect of screening on breast cancer mortality at the 10-year follow-up. Overall, the models captured the observed long-term effect of screening from age 40 to 49 years on breast cancer incidence and mortality in the UK Age trial, suggesting that the model structures, input parameters, and assumptions about breast cancer natural history are reasonable for estimating the impact of screening on mortality in this age group.

scholarly journals A magyarországi emlő- és méhnyakszűrés retrospektív vizsgálatának jellemzői a halálozási és megbetegedési adatok tükrében

2019 ◽  
Vol 160 (49) ◽  
pp. 1948-1956
Author(s):  
Attila Sárváry ◽  
Pál Csaba Bálint ◽  
Anikó Gyulai ◽  
Zsigmond Kósa
Keyword(s):  
Breast Cancer ◽  
Cervical Cancer ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Mortality And Morbidity ◽  
Screening Programs ◽  
In Situ Carcinoma ◽  
Cervical Cancer Mortality ◽  
Morbidity Data

Abstract: Introduction: The organized breast and cervical screening programs were implemented in the framework of public health program in Hungary in order to reduce breast cancer mortality by 30% and cervical cancer mortality by 60% in given age groups within 10 years by 2012. Aim: The aim of our study was to conduct a retrospective analysis of mortality and morbidity data and to evaluate the effectiveness of the implemented screening programs. Method: Descriptive statistical analysis was performed by age-standardized mortality and morbidity data between 1980 and 2015 with special regard to the period of 2002–2012. Results: Breast cancer mortality of women aged 45–64 reduced by 28.3%, the incidence reduced by 23.6% and the incidence of in situ carcinoma increased by 242% between 2002 and 2012. Cervical cancer mortality of women aged 25–64 years reduced by 25.5%, the incidence reduced by 21.2%, and the incidence of in situ carcinoma increased by 13.3% during 2002–2012. Conclusion: Although both breast cancer and cervical cancer mortality substantially decreased in Hungary, the decrease in cervical cancer did not reach the target value. Orv Hetil. 2019; 160(49): 1948–1956.

scholarly journals Breast cancer screening programmes in selected European countries and Poland

2021 ◽  
Vol 11 (7) ◽  
pp. 11-21
Author(s):  
Adam Jasiura ◽  
Izabela Dera ◽  
Karolina Szlachcic ◽  
Mateusz Gorzel ◽  
Joanna Zmonarska
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Mortality Rate ◽  
Breast Cancer Screening ◽  
Malignant Tumors ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
Screening Tests ◽  
The European Union ◽  
Screening Programs

Breast neoplasms are the most common malignant tumors among women. In recent years breast cancer incidence rate has increased. Due to this fact the European Union presents evidence-based guidelines on breast cancer screening and diagnosis. Recommended and commonly used screening test is mammography. The effectiveness of prophylaxis is measured by a decrease in breast cancer mortality rate. Detailed recommendations in EU member countries differ from those presented by the EU institutions. This paper compares the screening programme in Poland to screening programmes in other EU members. The evaluation considers compliance with European screening guidelines and changes in mortality rates since the introduction of the screening programs. General guidelines in Poland are close to European ones. However, some Polish health centers still use analog mammography instead of recommended digital mammography. Furthermore, mortality rate changes in Poland maintain on a constant level due to women’s reluctant participation in screening tests.

Breast cancer screening for carriers of ATM, CHEK2, and PALB2 pathogenic variants: A comparative modeling analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10500-10500
Author(s):  
Kathryn P. Lowry ◽  
H. Amarens Geuzinge ◽  
Natasha K. Stout ◽  
Oguzhan Alagoz ◽  
John M. Hampton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
Simulation Models ◽  
Pathogenic Variants ◽  
Life Years ◽  
Incidence And Mortality

10500 Background: Inherited pathogenic variants in ATM, CHEK2, and PALB2 confer moderate to high risks of breast cancer. The optimal approach to screening in these women has not been established. Methods: We used two simulation models from the Cancer Intervention and Surveillance Modeling Network (CISNET) and data from the Cancer Risk Estimates Related to Susceptibility consortium (CARRIERS) to project lifetime breast cancer incidence and mortality in ATM, CHEK2, and PALB2 carriers. We simulated screening with annual mammography from ages 40-74 alone and with annual magnetic resonance imaging (MRI) starting at ages 40, 35, 30, and 25. Joint and separate mammography and MRI screening performance was based on published literature. Lifetime outcomes per 1,000 women were reported as means and ranges across both models. Results: Estimated risk of breast cancer by age 80 was 22% (21-23%) for ATM, 28% (26-30%) for CHEK2, and 40% (38-42%) for PALB2. Screening with MRI and mammography reduced breast cancer mortality by 52-60% across variants (Table). Compared to no screening, starting MRI at age 30 increased life years (LY)/1000 women by 501 (478-523) in ATM, 620 (587-652) in CHEK2, and 1,025 (998-1,051) in PALB2. Starting MRI at age 25 versus 30 gained 9-12 LY/1000 women with 517-518 additional false positive screens and 197-198 benign biopsies. Conclusions: For women with ATM, CHEK2, and PALB2 pathogenic variants, breast cancer screening with MRI and mammography halves breast cancer mortality. These mortality benefits are similar to those for MRI screening for BRCA1/2 mutation carriers and should inform practice guidelines.[Table: see text]

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