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. 2021 Jan 15;148(2):406-418.
doi: 10.1002/ijc.33204. Epub 2020 Jul 30.

The potential of breast cancer screening in Europe

Nadine Zielonke  1 , Lindy M Kregting  1 , Eveline A M Heijnsdijk  1 , Piret Veerus  2 , Sirpa Heinävaara  3 , Martin McKee  4 , Inge M C M de Kok  1 , Harry J de Koning  1 , Nicolien T van Ravesteyn  1 ; EU-TOPIA collaborators  5
Affiliations

The potential of breast cancer screening in Europe

Nadine Zielonke et al. Int J Cancer. .

Abstract

Currently, all European countries offer some form of breast cancer screening. Nevertheless, disparities exist in the status of implementation, attendance and the extent of opportunistic screening. As a result, breast cancer screening has not yet reached its full potential. We examined how many breast cancer deaths could be prevented if all European countries would biennially screen all women aged 50 to 69 for breast cancer. We calculated the number of breast cancer deaths already prevented due to screening as well as the number of breast cancer deaths which could be additionally prevented if the total examination coverage (organised plus opportunistic) would reach 100%. The calculations are based on total examination coverage in women aged 50 to 69, the annual number of breast cancer deaths for women aged 50 to 74 and the maximal possible mortality reduction from breast cancer, assuming similar effectiveness of organised and opportunistic screening. The total examination coverage ranged from 49% (East), 62% (West), 64% (North) to 69% (South). Yearly 21 680 breast cancer deaths have already been prevented due to mammography screening. If all countries would reach 100% examination coverage, 12 434 additional breast cancer deaths could be prevented annually, with the biggest potential in Eastern Europe. With maximum coverage, 23% of their breast cancer deaths could be additionally prevented, while in Western Europe it could be 21%, in Southern Europe 15% and in Northern Europe 9%. Our study illustrates that by further optimising screening coverage, the number of breast cancer deaths in Europe can be lowered substantially.

Keywords: breast cancer mortality; breast cancer mortality reduction; breast cancer screening; screening coverage; screening guidelines.

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Conflict of interest statement

H. J. d. K. reports personal fees from the University of Zurich/MSD. All other authors of this paper report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
(Potential) breast cancer mortality reduction, per total examination coverage (example region North) [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Annual number of observed and preventable breast cancer deaths, ages 50 to 74, per European region [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Percentage of breast cancer deaths that could be additionally prevented if examination coverage would increase to 100%, per European country*. *Belgium is depicted as one country whereas in the calculation three highly autonomous regions Flanders, Wallonia and Brussels are included. These regions have very disparate screening programs for breast cancer (see Table 2) resulting in very different effects of an increased total examination coverage (Table 3). Only 8 of the 26 Swiss cantons have organised breast cancer screening programmes which causes substantial variation in the distribution of organised vs opportunistic screening across regions. On a national level, total examination coverage was only 25% in 2015 (14% organised and 11% opportunistic) according to the national expert. Thus, a national examination coverage of 100% would further reduce breast cancer deaths by 44% [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

References

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