Advanced breast cancer rates in the epoch of service screening: The 400,000 women cohort study from Italy

Puliti, Donella; Bucchi, Lauro; Mancini, Silvia; Paci, Euǵenio; Baracco, Susanna; Campari, Cinzia; Canuti, Debora; Crimi, Claudia; Collina, Natalina; Conti, Giovanni; Felice, Enza Di; Falcini, Fabio; Michiara, Maria; Negri, Rossella; Ravaioli, Alessandra; Bianchi, Priscilla Sassoli de; Serafini, Monica; Zorzi, Manuel; Caldarella, Adele; Cataliotti, Luigi; Zappa, Marco; Manneschi, Gianfranco; Miccinesi, Guido; Caranci, Nicola; Naldoni, Carlo; Finarelli, Alba Carola; Ferretti, Stefano; Pandolfi, Pier Paolo; Pizzi, Lorenzo; Petrucci, Cristina; Baldazzi, Paola; Pasquini, Anna; Manfredi, M.; Saguatti, Gianni; Zatelli, M; Sgargi, Paolo; Bozzani, F; Rossi, Paolo Giorgi; Mangone, Lucìa; Caroli, Stefania; Vicentini, Massimo; Vattiato, Rosa; Giuliani, Orietta; Balducci, Chiara; Vitali, B; Monticelli, G.

doi:10.1016/j.ejca.2016.12.030

Cited by 56 publications

(61 citation statements)

References 27 publications

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“…Differences between reviews were resolved through consensus by all four reviewers. Of the 60 full paper reviews in total, 22 studies were found eligible for inclusion in a comparison of incidence rates as the outcome measure [8, 12–15, 19, 29–44]. A further 9 studies were comparisons of proportions of advanced cancers and not included in the current review.…”

Section: Resultsmentioning

confidence: 99%

“…In most studies, the target age range was 50–69 years [8, 14, 15, 19, 29, 30, 32, 35–41, 44] or wider [12, 31, 43]. The papers from Finland, the West Midlands region of the UK, and Ireland reported programmes aimed at women aged 50–59 years [34] and 50–64 years [13, 42].…”

Section: Resultsmentioning

confidence: 99%

“…We assigned the design of the studies that evaluated the magnitude of effect to four broad categories:comparison of ABCR before and after the introduction of screening using different endpoints, i.e., annual percent change (APC), percent reduction in ABCR, absolute reduction in ABCR, incidence rate ratio (IRR), relative risk (RR), excess RR, slope value calculated from a log-linear Poisson regression model, and observed:expected ratio, or simply by juxtaposition of rates [8, 12, 15, 19, 29, 30, 32–40, 43, 44];comparison of ABCR between each year after the introduction of screening and the prescreening years using the estimated annual percent change (EAPC) [14, 31];calculation of the EAPC after the introduction of screening without information on prescreening years [13, 41]; andcomparison of ABCR in an invited population vs. a neighbouring uninvited one using the percent reduction in ABCR. This is the case for a single study [42], although the inclusion of neighbouring nonscreening areas is a secondary part of the design of other investigations [8, 36].…”

Section: Resultsmentioning

confidence: 99%

“…comparison of ABCR before and after the introduction of screening using different endpoints, i.e., annual percent change (APC), percent reduction in ABCR, absolute reduction in ABCR, incidence rate ratio (IRR), relative risk (RR), excess RR, slope value calculated from a log-linear Poisson regression model, and observed:expected ratio, or simply by juxtaposition of rates [8, 12, 15, 19, 29, 30, 32–40, 43, 44];…”

Section: Resultsmentioning

confidence: 99%

“…Because there is a latency for the effect of screening on ABCR to take place, at any point in time there are women (i.e., new quinquagenarians, new immigrants, and late attendees) with insufficient exposure time.The effect of screening on ABCR is underestimated, due to a disproportionate influence of prevalence screens.All studies3Pace of implementationPublic health screening programmes are implemented gradually, in a markedly stepwise fashion, since large populations are divided in distinct administrative units each targeted by an independent local plan of action.The effect of screening on ABCR is diluted. Until implementation is completed, there are women who are diagnosed with breast cancer before being invited, and who greatly contribute to ABCR.[8, 14, 15, 19, 29, 30, 32, 33, 36–39, 44]4Prevalence effectThe prevalence screen may be associated with a transient increase in ABCR [13]. During a stepwise implementation of the programme, when the time elapsed from the start is theoretically sufficient to see a decrease in ABCR, this is counteracted by an opposite effect due to newly enrolled women – especially if invitations increase over time.[8, 14, 15, 19, 29, 30, 32, 33, 36–39, 44]5Reference incidence (i)The reference (or underlying) incidence rate, with which to compare the rate observed after the introduction of screening, is not known with precision [49].…”

Section: Methodsmentioning

confidence: 99%

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The impact of mammography screening programmes on incidence of advanced breast cancer in Europe: a literature review

et al. 2018

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BackgroundObservational studies have reported conflicting results on the impact of mammography service screening programmes on the advanced breast cancer rate (ABCR), a correlation that was firmly established in randomized controlled trials. We reviewed and summarized studies of the effect of service screening programmes in the European Union on ABCR and discussed their limitations.MethodsThe PubMed database was searched for English language studies published between 01-01-2000 and 01–06-2018. After inspection of titles and abstracts, 220 of the 8644 potentially eligible papers were considered relevant. Their abstracts were reviewed by groups of two authors using predefined criteria. Fifty studies were selected for full paper review, and 22 of these were eligible. A theoretical framework for their review was developed. Review was performed using a ten-point checklist of the methodological caveats in the analysis of studies of ABCR and a standardised assessment form designed to extract quantitative and qualitative information.ResultsMost of the evaluable studies support a reduction in ABCR following the introduction of screening. However, all studies were challenged by issues of design and analysis which could at least potentially cause bias, and showed considerable variation in the estimated effect. Problems were observed in duration of follow-up time, availability of reliable reference ABCR, definition of advanced stage, temporal variation in the proportion of unknown-stage cancers, and statistical approach.ConclusionsWe conclude that much of the current controversy on the impact of service screening programmes on ABCR is due to observational data that were gathered and/or analysed with methodological approaches which could not capture stage effects in full. Future research on this important early indicator of screening effectiveness should focus on establishing consensus in the correct methodology.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4666-1) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

The impact of mammography screening programmes on incidence of advanced breast cancer in Europe: a literature review

et al. 2018

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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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Is the incidence of advanced‐stage breast cancer affected by whether women attend a steady‐state screening program?

Munck

Fracheboud

Bock

et al. 2018

Intl Journal of Cancer

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In this cross-sectional population-based study, we assessed the incidence of advanced breast cancer based on screening attendance. Women from the Netherlands Cancer Registry were included if aged ≥49 years and diagnosed with breast cancer between 2006 and 2011, and data were linked with the screening program. Cancers were defined as screen-related (diagnosed <24 months after screening) or nonscreened (all other breast cancers). Two cut-offs were used to define advanced breast cancer: TNM-stage (III-IV vs 0-I-II) and T-stage alone (≥15 mm vs <15 mm or DCIS). The incidence rates were adjusted for age and logistic regression was used to compare groups. Of the 72,612 included women diagnosed with breast cancer, 44,246 (61%) had screen-related breast cancer. By TNM stage, advanced cancer was almost three times as likely to be at an advanced TNM stage in the nonscreened group compared with the screen-related group (38 and 94 per 100,000, respectively; OR: 2.86, 95%CI: 2.72-3.00). By T-stage, the incidence of advanced cancer was higher overall, and in nonscreened women was significantly higher than in screened women (210 and 169 per 100,000; OR: 1.85, 95%CI: 1.78-1.93). Data on actual screening attendance showed that the incidence of advanced breast cancer was significantly higher in nonscreened women than in screened women, supporting the expectation that screening would cause a stage shift to early detection. Despite critical evaluations of breast cancer screening programs, our data show that breast cancer screening is a valuable tool that can reduce the disease burden in women.

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Advanced breast cancer rates in the epoch of service screening: The 400,000 women cohort study from Italy

Cited by 56 publications

References 27 publications

The impact of mammography screening programmes on incidence of advanced breast cancer in Europe: a literature review

The impact of mammography screening programmes on incidence of advanced breast cancer in Europe: a literature review

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

Is the incidence of advanced‐stage breast cancer affected by whether women attend a steady‐state screening program?

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