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. 2021 Oct 18;215(8):359-365.
doi: 10.5694/mja2.51216. Epub 2021 Aug 9.

Screening outcomes by risk factor and age: evidence from BreastScreen WA for discussions of risk-stratified population screening

Naomi Noguchi  1 , Michael L Marinovich  2 , Elizabeth J Wylie  3   4 , Helen G Lund  3 , Nehmat Houssami  5
Affiliations

Screening outcomes by risk factor and age: evidence from BreastScreen WA for discussions of risk-stratified population screening

Naomi Noguchi et al. Med J Aust. .

Abstract

Objectives: To estimate rates of screen-detected and interval breast cancers, stratified by risk factor, to inform discussions of risk-stratified population screening.

Design: Retrospective population-based cohort study; analysis of routinely collected BreastScreen WA program clinical and administrative data.

Setting, participants: All BreastScreen WA mammography screening episodes for women aged 40 years or more during 1 July 2007 - 30 June 2017.

Main outcome measures: Cancer detection rate (CDR) and interval cancer rate (ICR), by risk factor.

Results: A total of 323 082 women were screened in 1 026 137 screening episodes (mean age, 58.5 years; SD, 8.6 years). The overall CDR was 68 (95% CI, 67-70) cancers per 10 000 screens, and the overall ICR was 9.7 (95% CI, 9.2-10.1) cancers per 10 000 women-years. Interactions between the effects on CDR of age group and five risk factors were statistically significant: personal history of breast cancer (P = 0.039), family history of breast cancer (P = 0.005), risk-relevant benign conditions (P = 0.012), hormone-replacement therapy (P = 0.002), and self-reported symptoms (P < 0.001). The influence of these risk factors (except personal history) increased with age. For ICR, only the interaction between age and hormone-replacement therapy was significant (P < 0.001), although weak interactions between age and family history of breast cancer or having dense breasts were noted (each P = 0.07). The influence of family history on ICR was significant only for women aged 40-49 years.

Conclusions: Screening CDR and (for some risk factors) ICR were higher for women in some age groups with personal histories of breast cancer or risk-relevant benign breast conditions or first degree family history of breast cancer, women with dense breasts or self-reported breast-related symptoms, and women using hormone-replacement therapy. Our findings could inform the evaluation of risk-based screening.

Keywords: Breast neoplasms; Epidemiology; Mammography; Mass screening; Population health; Risk factors.

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Conflict of interest statement

No relevant disclosures.

Figures

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* The data for these graphs are included in the online Supporting Information, table 3.
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The data for these graphs are included in the online Supporting Information, table 4.
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References

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