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. 2004 Aug 31;91(5):861-7.
doi: 10.1038/sj.bjc.6602075.

Decreased rates of advanced breast cancer due to mammography screening in The Netherlands

J Fracheboud  1 , S J Otto, J A A M van Dijck, M J M Broeders, A L M Verbeek, H J de Koning; National Evaluation Team for Breast cancer screening (NETB)
Affiliations

Decreased rates of advanced breast cancer due to mammography screening in The Netherlands

J Fracheboud et al. Br J Cancer. .

Abstract

The effect of the implementation of the Dutch breast cancer screening programme during 1990-1997 on the incidence rates of breast cancer, particularly advanced breast cancer, was analysed according to stage at diagnosis in seven regions, where no screening took place before 1990. The Netherlands Cancer Registry provided detailed data on breast cancer incidence in 1989-1997 by tumour stage, age and region. Annual age-adjusted incidence rates of all breast cancers and advanced cancers, defined as large tumours T2+ with lymph node and/or distant metastases, were compared with rates in 1989. In general, breast cancer incidence rose strongly in the early 1990s, especially in the age category 50-69 years (estimated annual percentage change (EAPC) 4.25; 95% CI 1.70, 6.86). The increase was mainly due to the increase in small T1 cancers and ductal carcinoma in situ. However, in women aged 50-69, advanced cancer incidence rates showed a significant decline by 12.1% in 1997 compared with 1989 (EAPC -2.14, 95% CI -3.47, -0.80), followed by a breast cancer mortality reduction of similar size after approximately 2 years. We confirm that breast cancer screening initially leads to a temporary strong increase in the breast cancer incidence, which is followed by a significant decrease in advanced diseases in the women invited for screening. It is evident that breast cancer screening contributes to a reduction in advanced breast cancers and breast cancer mortality.

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Figures

Figure 1
Figure 1
Age-adjusted invasive and in situ breast cancer incidence per 100 000 by age category, seven ‘new’ regions 1989–1997.
Figure 2
Figure 2
Percent distribution of newly diagnosed invasive and in situ breast cancers as related to screening (screen-detected; in ever-screened women, in never-screened women and unknown) by age category 1990–1997.
Figure 3
Figure 3
Age-adjusted invasive breast cancer rates (ESR) in 1989–1997 per 100 000 by tumour stage in seven ‘new’ regions: (A) all ages; (B) <50 years; (C) 50–69 years; (D) >69 years.
See this image and copyright information in PMC

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