Breast cancer incidence as a function of the number of previous mammograms: analysis of the NHS screening programme

Mapping Intimacies ◽

10.1101/238527 ◽

2017 ◽

Author(s):

Daniel Corcos

Keyword(s):

Breast Cancer ◽

Cancer Incidence ◽

Mammography Screening ◽

Screening Programme ◽

Breast Cancer Incidence ◽

X Ray ◽

Screening Programs ◽

The United Kingdom ◽

Cancer Screening Programme ◽

The Uk

AbstractThe discrepancy between the protective effect of early surgery of breast cancer and the poor benefits of mammography screening programs in the long term can be explained if mammography induces breast cancer at a much higher rate than anticipated. Mammography screening is associated in most countries with a higher incidence of breast cancer, attributed to overdiagnosis. X-ray-induced cancers can be distinguished from overdiagnosed cancers by the fact that their incidence depends on the number of previous mammograms, whereas overdiagnosis solely depends on the last screening mammogram, leading to diagnosis. The unbiased relationship between the number of mammograms and breast cancer incidence was evaluated from the data of the NHS Breast Cancer screening programme in women aged from 50 to 64 years in the United Kingdom. The delay between mammography and increased breast cancer incidence was confirmed from the data of the “Age” trial, a randomized trial of annual screening starting at age 40 in the UK. In women aged 50-64 attending screening at the NHS Breast Cancer programme, in situ breast cancer incidence increased linearly from 1993 to 2005 as a function of the number of mammograms. Incidence did not increase anymore after 2005 when the number of mammograms and the delay after screening was stable. Invasive breast cancer incidence increased more specifically in the 60-69 age group. The risk of breast cancer almost doubled after 15 years of screening. Additional cancers began to occur less than 6 years after mammography. These results are evidence that X-ray-induced carcinogenesis, rather than overdiagnosis, is the cause of the increase in breast cancer incidence.

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Absence of sustained breast cancer incidence inflation in a national mammography screening programme

Journal of Medical Screening ◽

10.1177/0969141318775766 ◽

2018 ◽

Vol 26 (1) ◽

pp. 26-34 ◽

Cited By ~ 1

Author(s):

Stephen Morrell ◽

Marli Gregory ◽

Kerry Sexton ◽

Jessica Wharton ◽

Nisha Sharma ◽

...

Keyword(s):

Breast Cancer ◽

New Zealand ◽

Cancer Incidence ◽

Invasive Breast Cancer ◽

Mammography Screening ◽

Screening Programme ◽

Breast Cancer Incidence ◽

Age Groups ◽

Incidence Trends ◽

The Impact

Objective To investigate the impact of population mammography screening on breast cancer incidence trends in New Zealand. Methods Trends in age-specific rates of invasive breast cancer incidence (1994–2014) were assessed in relation to screening in women aged 50–64 from 1999 and 45–69 following the programme age extension in mid-2004. Results Breast cancer incidence increased significantly by 18% in women aged 50–64 compared with 1994–98 (p<0.0001), coinciding with the 1999 introduction of mammography screening, and remained elevated for four years, before declining to pre-screening levels. Increases over 1994–99 incidence occurred in the 45–49 (21%) and 65–69 (19%) age groups following the 2004 age extension (p<0.0001). Following establishment of screening (2006–10), elevated incidence in the screening target age groups was compensated for by lower incidence in the post-screening ⩾70 age groups than in 1994–98. Incidence in women aged ⩾45 was not significantly higher (+5%) after 2006 than in 1994–98. The cumulated risk of breast cancer in women aged 45–84 for 1994–98 was 10.7% compared with 10.8% in 2006–10. Conclusions Increases in breast cancer incidence following introduction of mammography screening in women aged 50–64 did not persist. Incidence inflation also occurred after introduction of screening for age groups 45–49 and 65–69. The cumulated incidence for women aged 45–84 over 2006–10 after screening was well established, compared with 1994–98 prior to screening, shows no increase in diagnosis. Over-diagnosis is not inevitable in population mammography screening programmes.

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

Medical Decision Making ◽

10.1177/0272989x17718168 ◽

2018 ◽

Vol 38 (1_suppl) ◽

pp. 140S-150S ◽

Cited By ~ 4

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.

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