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. 2020 Jul 1;126(13):2971-2979.
doi: 10.1002/cncr.32859. Epub 2020 May 11.

Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549,091 women

Stephen W Duffy  1 , László Tabár  2 , Amy Ming-Fang Yen  3 , Peter B Dean  4 , Robert A Smith  5 , Håkan Jonsson  6 , Sven Törnberg  7 , Sam Li-Sheng Chen  3 , Sherry Yueh-Hsia Chiu  8 , Jean Ching-Yuan Fann  9 , May Mei-Sheng Ku  10 , Wendy Yi-Ying Wu  6 , Chen-Yang Hsu  10 , Yu-Ching Chen  11 , Gunilla Svane  7 , Edward Azavedo  7 , Helene Grundström  12 , Per Sundén  12 , Karin Leifland  13 , Ewa Frodis  14 , Joakim Ramos  14 , Birgitta Epstein  15 , Anders Åkerlund  16 , Ann Sundbom  17 , Pál Bordás  18 , Hans Wallin  19 , Leena Starck  19 , Annika Björkgren  20 , Stina Carlson  20 , Irma Fredriksson  7 , Johan Ahlgren  21 , Daniel Öhman  22 , Lars Holmberg  23 , Tony Hsiu-Hsi Chen  10
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Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549,091 women

Stephen W Duffy et al. Cancer. .

Abstract

Background: It is of paramount importance to evaluate the impact of participation in organized mammography service screening independently from changes in breast cancer treatment. This can be done by measuring the incidence of fatal breast cancer, which is based on the date of diagnosis and not on the date of death.

Methods: Among 549,091 women, covering approximately 30% of the Swedish screening-eligible population, the authors calculated the incidence rates of 2473 breast cancers that were fatal within 10 years after diagnosis and the incidence rates of 9737 advanced breast cancers. Data regarding each breast cancer diagnosis and the cause and date of death of each breast cancer case were gathered from national Swedish registries. Tumor characteristics were collected from regional cancer centers. Aggregated data concerning invitation and participation were provided by Sectra Medical Systems AB. Incidence rates were analyzed using Poisson regression.

Results: Women who participated in mammography screening had a statistically significant 41% reduction in their risk of dying of breast cancer within 10 years (relative risk, 0.59; 95% CI, 0.51-0.68 [P < .001]) and a 25% reduction in the rate of advanced breast cancers (relative risk, 0.75; 95% CI, 0.66-0.84 [P < .001]).

Conclusions: Substantial reductions in the incidence rate of breast cancers that were fatal within 10 years after diagnosis and in the advanced breast cancer rate were found in this contemporaneous comparison of women participating versus those not participating in screening. These benefits appeared to be independent of recent changes in treatment regimens.

Keywords: breast cancer; fatality; mammography; mortality; screening.

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Conflict of interest statement

László Tabár received personal fees from General Electric Healthcare for the preparation of automated breast ultrasound teaching cases as well as honoraria and travel costs to attend speaking engagements; personal fees from Mammography Education Inc in his capacity as president of the company, which organizes continuing medical education courses regarding breast imaging; and personal fees from Three Palm Software for consultation related to breast imaging interpretation, all for work performed outside of the current study. The authors do not consider these conflicts of interest but disclose them for completeness. The other authors made no disclosures.

Figures

Figure 1
Figure 1
Map of Sweden showing the locations of the 9 counties (each indicated administratively in Sweden by one or two letters of the alphabet) involved in the current study.
Figure 2
Figure 2
Meta‐analysis of the relative risks of breast cancer that was fatal within 10 years after diagnosis.
Figure 3
Figure 3
Cumulative incidence of breast cancer that was fatal within 10 years after diagnosis for all 9 counties combined.
Figure 4
Figure 4
Meta‐analysis of the relative risks of advanced breast cancer.
Figure 5
Figure 5
Cumulative incidence of advanced breast cancer for all 9 counties combined.
See this image and copyright information in PMC

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