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. 2020 Mar 4;20(1):174.
doi: 10.1186/s12885-020-6646-5.

Incidence of advanced-stage breast cancer in regular participants of a mammography screening program: a prospective register-based study

Laura Khil  1 , Jan Heidrich  2   3 , Ina Wellmann  2   4 , Vanessa Kääb-Sanyal  5 , Stefanie Weigel  6 , Walter Heindel  6 , Hans-Werner Hense  2   4 , Oliver Heidinger  2
Affiliations

Incidence of advanced-stage breast cancer in regular participants of a mammography screening program: a prospective register-based study

Laura Khil et al. BMC Cancer. .

Abstract

Background: The European Guidelines for breast cancer screening suggest that the impact of population-based mammography screening programmes (MSP) may be assessed using the relative reduction in the incidence of advanced breast cancer (ABC, that is, stage UICC II and higher) as a surrogate indicator of screening effectiveness.

Methods: This prospective, population register-based study contained individual data of 1,200,246 women (aged 50-69 years) who attended the initial prevalence screening between 2005 and 2009. Of them, 498,029 women returned for the regular (i.e., within 24 months) first subsequent, and 208,561 for the regular second subsequent incidence screenings. The incidence rate of ABC was calculated for the 24-months period following, but not including, the initial screening by incorporating all interval ABCs and all ABCs detected at the regular first incidence screening; the ABC rate for the second 24-months period was determined in the same way, including ABCs detected in the interval after the first and, respectively, at the second incidence screening. The relative reduction in the ABC incidence was derived by comparing the age-standardized rates in these two periods with an age-standardized reference incidence rate, observed in the target population before the MSP implementation. The strengths and weaknesses of this particular study design were contrasted with a recently published checklist of main methodological problems affecting studies of the effect of MSP on ABC incidence.

Results: The age-standardized ABC incidence rate was 291.6 per 100,000 women for the 24-months period subsequent to the initial screening, and 275.0/100,000 for the 24-months period following the first subsequent screening. Compared to the 2-year incidence of 349.4/100,000 before the start of the MSP, this amounted to a relative reduction of 16.5 and 21.3%, respectively, in the incidence of ABC among regular MSP participants.

Conclusions: The design employed in this study avoids some of the substantial methodological limitations that compromised previous observational studies. Nevertheless, specific limitations prevail that demand a cautious interpretation of the results. Therefore, the study findings, indicating a reduction in ABC for regular MSP participants, need to be followed with respect to potential impacts on breast cancer mortality rates.

Keywords: Advanced breast cancer - mammography screening programme - incidence rate reduction - population-based cancer registry.

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Conflict of interest statement

LK, OH, JH, WH, SW and HWH are or have been speakers for UKM Akademie GmbH at continuing professional development events on the qualification, ongoing training, and further professional development of mammography screening program doctors and radiologists and have received payment for this work. WH runs the Mammography Reference Centre, a third-party funded project at Münster University Hospital. He manages other third-party funding for research projects into breast cancer screening of the EU and the German Federal Office for Radiation Protection (BfS, Bundesamt für Strahlenschutz). HWH manages third-party funding of the German Federal Office for Radiation Protection (BfS, Bundesamt für Strahlenschutz) for research projects into breast cancer screening. IW and VKS have nothing to disclose.

Figures

Fig. 1
Fig. 1
Flow diagram of the study population by screening examination
See this image and copyright information in PMC

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