A case–control study to evaluate the impact of the breast screening programme on breast cancer incidence in England

Blyuss, Oleg; Dibden, Amanda; Massat, Nathalie J.; Parmar, Dharmishta; Cuzick, Jack; Duffy, Stephen W.; Sasieni, Peter

doi:10.1002/cam4.5004

Cited by 9 publications

(14 citation statements)

References 17 publications

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“…The most recent study of overdiagnosis is a case–control study nested within the screening program in England. The odds ratio for ever having attended screening was 1.22 (CI 1.18–1.26) (attributable fraction 18%) 16 …”

Section: Discussionmentioning

confidence: 99%

“…The odds ratio for ever having attended screening was 1.22 (CI 1.18-1.26) (attributable fraction 18%). 16 Despite differences in comparison groups and methods, including biases, results from cohort studies and case-control studies are reasonably consistent, with attributable fractions around 20% or smaller.…”

Section: Overdiagnosismentioning

confidence: 91%

“…10 In contrast, cohort studies can be used to estimate risk, but of the 40 analyses of overdiagnosis described in the IARC handbook, only 10 were cohort studies. 1 Several cohort studies and one case-control study were published after the IARC handbook [11][12][13][14][15][16] ; one by Lund et al 13 updated an earlier analysis. 17 Quantifying the balance of benefits and harms of screening is important for helping women to make informed choices about whether to participate in screening, but estimates differ.…”

Section: Introductionmentioning

confidence: 99%

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Benefits and harms of breast cancer screening: Cohort study of breast cancer mortality and overdiagnosis

Wang,

Sultana,

Kavanagh

et al. 2023

Cancer Medicine

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BackgroundQuantifying the benefits and harms of breast cancer screening accurately is important for planning and evaluating screening programs and for enabling women to make informed decisions about participation. However, few cohort studies have attempted to estimate benefit and harm simultaneously.AimsWe aimed to quantify the impact of mammographic screening on breast cancer mortality and overdiagnosis using a cohort of women invited to attend Australia's national screening program, BreastScreen.MethodsIn a cohort of 41,330 women without prior breast cancer diagnosis, screening, or diagnostic procedures invited to attend BreastScreen Western Australia in 1994‐1995, we estimated the cumulative risk of breast cancer mortality and breast cancer incidence (invasive and ductal carcinoma in situ) from age 50 to 85 years for attenders and non‐attenders. Data were obtained by linking population‐based state and national health registries. Breast cancer mortality risks were estimated from a survival analysis that accounted for competing risk of death from other causes. Breast cancer risk for unscreened women was estimated by survival analysis, while accounting for competing causes of death. For screened women, breast cancer risk was the sum of risk of being diagnosed at first screen, estimated using logistic regression, and risk of diagnosis following a negative first screen estimated from a survival analysis.ResultsFor every 1,000 women 50 years old at first invitation to attend BreastScreen, there were 20 (95% CI 12‐30) fewer breast cancer deaths and 25 (95% CI 15‐35) more breast cancers diagnosed for women who attended than for non‐attendees by age 85. Of the breast cancers diagnosed in screened women, 21% (95% CI 13%‐27%) could be attributed to screening.DiscussionThe estimated ratio of benefit to harm was consistent with, but slightly less favourable to screening than most other estimates from cohort studies.ConclusionWomen who participate in organised screening for breast cancer in Australia have substantially lower breast cancer mortality, while some screen‐detected cancers may be overdiagnosed.

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Section: Discussionmentioning

confidence: 99%

Section: Overdiagnosismentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Benefits and harms of breast cancer screening: Cohort study of breast cancer mortality and overdiagnosis

Wang,

Sultana,

Kavanagh

et al. 2023

Cancer Medicine

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“…For example, for breast cancer screening with short term follow up many cancers were found which did not appear to require treatment, leading to the belief that up to 50% of the screen detected cancers were over-diagnosis of indolent cancers that would not be clinically detected in the woman's lifetime [8], and this was a drawback of breast screening. However, with longer follow up [9] these cancers were found to be earlier diagnosis of clinically relevant disease, and it was estimated that of the total number of screen detected cancers in the screened population, only 9.5% overall were over-diagnosed, and this was reduced to 3.7% after adjustment for self-selection. Thus, long-term follow up, even after screening has ended, is necessary to accurately assess over-diagnosis.…”

Section: Screening Trialsmentioning

confidence: 99%

The importance of long-term follow up of participants in clinical trials

Cuzick

2022

Br J Cancer

Self Cite

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“…Risk stratification may lead to earlier diagnosis and improved patient outcomes for women at high risk of breast cancer through targeted mammographic surveillance and triggering more timely advice on lifestyle and chemoprevention. Risk stratification may also potentially reduce harms from overdiagnosis and false positive findings, through identification of low-risk women requiring less mammographic surveillance [ 4 , 5 , 6 ]. PRS testing of selected SNPs using DNA microarrays is quick and low-cost.…”

Section: Introductionmentioning

confidence: 99%

Risk-Stratified Breast Cancer Screening Incorporating a Polygenic Risk Score: A Survey of UK General Practitioners’ Knowledge and Attitudes

Ayoub

Lapointe

Nabi

et al. 2023

Genes

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A polygenic risk score (PRS) quantifies the aggregated effects of common genetic variants in an individual. A ‘personalised breast cancer risk assessment’ combines PRS with other genetic and nongenetic risk factors to offer risk-stratified screening and interventions. Large-scale studies are evaluating the clinical utility and feasibility of implementing risk-stratified screening; however, General Practitioners’ (GPs) views remain largely unknown. This study aimed to explore GPs’: (i) knowledge of risk-stratified screening; (ii) attitudes towards risk-stratified screening; and (iii) preferences for continuing professional development. A cross-sectional online survey of UK GPs was conducted between July–August 2022. The survey was distributed by the Royal College of General Practitioners and via other mailing lists and social media. In total, 109 GPs completed the survey; 49% were not familiar with the concept of PRS. Regarding risk-stratified screening pathways, 75% agreed with earlier and more frequent screening for women at high risk, 43% neither agreed nor disagreed with later and less screening for women at lower-than-average risk, and 55% disagreed with completely removing screening for women at much lower risk. In total, 81% felt positive about the potential impact of risk-stratified screening towards patients and 62% felt positive about the potential impact on their practice. GPs selected training of healthcare professionals as the priority for future risk-stratified screening implementation, preferring online formats for learning. The results suggest limited knowledge of PRS and risk-stratified screening amongst GPs. Training—preferably using online learning formats—was identified as the top priority for future implementation. GPs felt positive about the potential impact of risk-stratified screening; however, there was hesitance and disagreement towards a low-risk screening pathway.

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A case–control study to evaluate the impact of the breast screening programme on breast cancer incidence in England

Abstract: A case-control study to evaluate the impact of the breast screening programme on breast cancer incidence in England. Cancer Medicine.

Cited by 9 publications

References 17 publications

Benefits and harms of breast cancer screening: Cohort study of breast cancer mortality and overdiagnosis

Benefits and harms of breast cancer screening: Cohort study of breast cancer mortality and overdiagnosis

The importance of long-term follow up of participants in clinical trials

Risk-Stratified Breast Cancer Screening Incorporating a Polygenic Risk Score: A Survey of UK General Practitioners’ Knowledge and Attitudes

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