Screening mammography program of British Columbia

1544 Background: There is ongoing debate about the role of screening mammography and its impact on overall survival in breast cancer. We hypothesized that women with screen-detected breast cancers (SDBC) receive less surgery, regional radiotherapy (RRT), and chemotherapy (CH) than women with non-screen-detected breast cancers (NSDBC). Less therapy equates to less personal and societal burden, including less time away from work, fewer side effects, lower health care and disability costs, and reduced psychosocial distress. These may be adequate justification for screening programs even in the absence of an overall survival benefit. Methods: Women aged 40-79 years with stage 0-III breast cancers diagnosed between 2007-2012 and referred to the British Columbia Cancer Agency were identified using the Breast Cancer Outcomes Unit database. Clinical and tumor characteristics and type/extent of treatment were extracted. Linkage with the Screening Mammography Program of British Columbia segregated cases into SDBCs and NSDBCs. Interval breast cancers arising in regularly screened women (minimum 2-year interval) were excluded. Results: We identified 12,393 women; 7807 with SDBC and 4586 with NSDBC. Compared with NSDBCs, SDBCs were lower stage, less often treated with mastectomy and CH, and occurred in slightly older women (Table 1). SDBC received more radiation than NSDBC. Conclusions: Women with NSDBC are more likely to present with higher stage breast cancer. Rates of mastectomy and CH were 20% higher in NSDBC whereas SDBC had a modest 5% higher rate of RRT. These findings suggest that screening mammography decreases the extent of local and systemic treatment for breast cancer. [Table: see text]

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Re: Interval breast cancers in the screening mammography program of British Columbia: analysis and classification.

American Journal of Roentgenology ◽

10.2214/ajr.164.5.7717258 ◽

1995 ◽

Vol 164 (5) ◽

pp. 1298-1299 ◽

Cited By ~ 2

Author(s):

D B Kopans

Keyword(s):

British Columbia ◽

Screening Mammography ◽

Breast Cancers

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Outcomes of an organized breast cancer screening program over the past 15 years.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.14 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 14-14

Author(s):

Rasika Rajapakshe ◽

Brent Parker ◽

Cynthia Araujo ◽

Christina Chu ◽

Christine Wilson ◽

...

Keyword(s):

Breast Cancer ◽

British Columbia ◽

Cancer Detection ◽

Detection Rate ◽

Screening Program ◽

Participation Rate ◽

Screening Mammography ◽

Cancer Detection Rate ◽

Stable Range ◽

The Past

14 Background: Founded in 1988, The Screening Mammography Program of British Columbia (SMPBC) is a large, and stable screening program and a formal review of its effectiveness provides suggestions for further improvements. The purpose of this study is to quantify and report trends of the SMPBC and to assess if there have been any major changes in outcomes over the past fifteen years as this program has matured. Methods: A retrospective review of the SMPBC was performed by extracting data from the past 15 years from the SMPBC Annual Reports. The changes and trends in percentage of eligible population screened/participation rate, number of screening exams and number of first screens performed, overall cancer detection rate, and DCIS detection rate was extracted and reported. Furthermore, cost analysis data was extracted, and adjusted to compensate for inflation using The Bank of Canada Inflation Calculator, which bases its calculations from the Canadian Consumer Price Index (CPI) from Statistics Canada. Results: Over the past 15 years, the total number of exams provided per year has almost doubled from 166,746 in 1996 to 303,157 in 2010, and this increase accommodates the overall and aging growth of the BC population. An increasing participation rate is seen from 1999-2009 for women from rural sites and traditionally underserved areas of British Columbia, while the overall participation rate over this time period remains stable (range 48%-51%). The cancer detection rate also remains stable (range: 3.4-4.5 cases per 1000 screens). After adjusting for inflation, a 12.6% increase in the cost per screen from 1995-2009 is observed. This increase is multifactorial and includes an increase in operating costs central services and physician reading fees. Conclusions: The province of British Columbia has consistently had the lowest rates of breast cancer related mortality in Canada, and this may be, in part, because of the long term stability of the BC Screening Mammography Program. Our report suggests that the SMPBC has been effective in accommodating the growing aging population, although there is still room for improvement, as a target participation of 70% is considered the standard to effectively reduce mortality through screening.

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Breast cancer mortality after screening mammography in British Columbia women

International Journal of Cancer ◽

10.1002/ijc.22249 ◽

2006 ◽

Vol 120 (5) ◽

pp. 1076-1080 ◽

Cited By ~ 66

Author(s):

Andrew Coldman ◽

Norm Phillips ◽

Linda Warren ◽

Lisa Kan

Keyword(s):

Breast Cancer ◽

British Columbia ◽

Cancer Mortality ◽

Breast Cancer Mortality ◽

Screening Mammography

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Prognosis, treatment, and recurrence of breast cancer for women attending or not attending the Screening Mammography Program of British Columbia

Breast Cancer Research and Treatment ◽

10.1023/a:1006152918283 ◽

1999 ◽

Vol 54 (1) ◽

pp. 73-81 ◽

Cited By ~ 30

Author(s):

Ivo A. Olivotto ◽

Donna Mates ◽

Lisa Kan ◽

Jonathan Fung ◽

Rajiv Samant ◽

...

Keyword(s):

Breast Cancer ◽

British Columbia ◽

Screening Mammography

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Estimation of additional MRI resources needed in British Columbia for screening high-risk women for breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.51 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 51-51

Author(s):

Rasika Rajapakshe ◽

Christabelle Bitgood ◽

Steven McAvoy ◽

Cynthia Araujo ◽

Paula Gordon ◽

...

Keyword(s):

Breast Cancer ◽

British Columbia ◽

Family History ◽

High Risk ◽

Screening Mammography ◽

Low Risk ◽

Moderate Risk ◽

High Risk Women ◽

Risk Distribution ◽

Victoria General Hospital

51 Background: Screening women at high risk with MRI has been shown to detect breast cancer at an early stage. Therefore, MRI screening has been recommended in the UK and USA for women who are at a high risk of developing breast cancer. However, there is no information available in the province of British Columbia (BC) about the number of women who have a high risk of developing breast cancer. Therefore, we carried out a study to estimate the breast cancer risk distribution in three sample populations in BC using Tyrer-Cuzick (TC) risk prediction model so that additional resource requirement for MRI breast screening can be calculated. Methods: A survey questionnaire was designed based on the TC model, which includes family history, hormonal factors, and benign breast disease. Additional questions also include factors that are used in other models (Gail, Claus, and BCRAPRO) as well as factors that may be included in the future. Women were recruited by staff and volunteers at three screening mammography clinics: Kelowna, Victoria General Hospital, and BC Women’s Health Centre in Vancouver. The survey was available to women to complete on the web, by phone, or on paper. An online database was constructed to store and query the data. The 10-year risk of developing breast cancer for each woman was calculated using the Tyrer-Cuzick IBIS Risk Evaluator software and the risk distribution of the survey population was analyzed. Results: Data from 3,200 women recruited from three sites, gives a risk distribution showing 2.6% are at high risk of developing breast cancer, 31.2% are at moderate risk, and 66.2% are at low risk. Based on NICE guidelines (UK), high risk is defined as having a 10-year risk of greater than 8%, moderate risk as 3-8%, and low risk as less than 3%. Extrapolating this to the approximately 500,000 women who are eligible to attend for screening mammography in BC, 13,000 women are considered at high risk. Conclusions: Our results indicate that 2.6% of women ages 40-79 attending screening mammography in BC may have a very high risk of developing breast cancer based on personal and family history. Based on a 14-hour work day, three additional MRI scanners would be required to implement MRI screening for these high-risk women in BC.

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Impact of changing from annual to biennial mammographic screening on breast cancer outcomes in women aged 50–79 in British Columbia

Journal of Medical Screening ◽

10.1258/jms.2008.008064 ◽

2008 ◽

Vol 15 (4) ◽

pp. 182-187 ◽

Cited By ~ 6

Author(s):

Andrew J Coldman ◽

Norm Phillips ◽

Ivo A Olivotto ◽

Paula Gordon ◽

Linda Warren ◽

...

Keyword(s):

Breast Cancer ◽

British Columbia ◽

Cancer Mortality ◽

Breast Cancer Mortality ◽

Mortality Rates ◽

Screening Mammography ◽

Axillary Node ◽

Age Group ◽

Cancer Outcomes ◽

Breast Cancer Outcomes

Objectives The objective of this study was to compare breast cancer outcomes among women subject to different policies on mammography screening frequency. Setting Data were obtained for women participating in the Screening Mammography Programme of British Columbia (SMPBC) for 1988–2005. The SMPBC changed its policy for women aged 50–79 years from annual to biennial mammography in 1997, but retained an annual recommendation for women aged 40–49 years. Methods Breast cancer outcomes were compared for women participating in the programme before and after 1997 for two groups: ages 40–49 and 50–79 years. Results There were data on 658,151 women. Comparing pre-1997 and post-1997, the median interscreen interval increased by 11.1 months in women 50–79 but by only 0.3 months in women aged 40–49. Excluding those detected at initial screen, 6291 breast cancers were identified. Comparing pre-1997 and post-1997: the relative rates (RR) of screen detected cancer increased in women aged 40–49 (RR = 1.32) and the rate of invasive cancers ≥20 mm at diagnosis decreased (RR = 0.83); the rate of cancers with axillary node involvement increased in women aged 50–79 (RR = 1.23). Cancer survival improved after 1997 for women diagnosed at ages 40–49 (hazard ratio = 0.62), but was unchanged for women aged 50–79. Breast cancer mortality rates did not change between the periods in either age group. Conclusion The proximal cancer outcomes considered (staging and survival) improved in women aged 40–49 but this was offset in women aged 50–79 associated with the change in screen frequency. These changes did not result in alterations in breast cancer mortality rates in either age group.

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