Assessing the effectiveness of a mammography screening service

Clayforth, Cassandra; Fritschi, Lin; McEvoy, Suzanne; Byrne, Michael; Wylie, Elizabeth; Threlfall, Tim; Sterrett, Gregory F.; Harvey, Jennet; Jamrozik, Konrad

doi:10.1111/j.1445-2197.2005.03476.x

Cited by 7 publications

(15 citation statements)

References 32 publications

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“…This resulted in symptomatic breast cancers being seven times more likely to be diagnosed at stage III-IV than stage I compared with rescreen-detected breast cancer. This is consistent with previous studies where all screens were included and screen-detected breast cancers were more likely to be smaller in size (Schroen et al, 1996;Klemi et al, 1997;Cowan et al, 2000;Groenendijk et al, 2003;Dillon et al, 2004;Clayforth et al, 2005), axillary node negative (Schroen et al, 1996;Klemi et al, 1997;Groenendijk et al, 2003;Dillon et al, 2004) and of lower stage than symptomatic cancers (Brekelmans et al, 1995;Klemi et al, 1997). Our study also concurs with other studies examining prognostic factors by screening round that found rescreen-detected breast cancers to be of smaller size and have a lower rate of axillary node metastases (Hakama et al, 1995;Vitak et al, 1997;Paci et al, 2005;Burke et al, 2008) and a lower stage (Vitak et al, 1997) than symptomatic cancers.…”

Section: Discussionsupporting

confidence: 94%

“…However, the only other study that compared rescreen-detected breast cancers with interval cancers reported an overall significant difference by stage for prevalent screens and not for incident screens (Vitak et al, 1997). Many studies have reported significantly higher histological grades for interval (Burrell et al, 1996;Klemi et al, 1997;Crosier et al, 1999;Porter et al, 1999;Cowan et al, 2000;Gilliland et al, 2000;Domingo et al, 2010) and symptomatic cancers (Klemi et al, 1997;Cowan et al, 2000;Dillon et al, 2004;Clayforth et al, 2005;Burke et al, 2008) compared with screen-detected cancers. Our study also found a higher proportion of grade 3 versus 1 for interval (31.6%) and symptomatic (39.6%) breast cancers compared with subsequent screen-detected cancers (25.6%), with the difference being significant only for the comparison with symptomatic breast cancers.…”

Section: Discussionmentioning

confidence: 91%

“…The majority of the improvement in prognosis between screen-detected cancers and symptomatic cancers has been reported to be because of differences in pathological features such as size, nodal status and grade (Nagtegaal et al, 2011). Several studies have shown screen-detected breast cancers to be smaller in size (Hakama et al, 1995;Schroen et al, 1996;Klemi et al, 1997;Cowan et al, 2000;Groenendijk et al, 2003;Dillon et al, 2004;Clayforth et al, 2005;Burke et al, 2008), axillary node negative (Hakama et al, 1995;Schroen et al, 1996;Klemi et al, 1997;Groenendijk et al, 2003;Dillon et al, 2004;Burke et al, 2008) and of lower grade (Klemi et al, 1997;Cowan et al, 2000;Dillon et al, 2004;Clayforth et al, 2005;Burke et al, 2008) than symptomatic cancers.…”

Section: Introductionmentioning

confidence: 96%

“…Previous studies have found that screening tends to detect early stage breast cancers with a lower metastatic potential and a more favourable prognosis when compared with symptomatic breast cancers (Hakama et al, 1995;Garvican and Littlejohns, 1998;Dillon et al, 2004;Clayforth et al, 2005;Burke et al, 2008). The majority of the improvement in prognosis between screen-detected cancers and symptomatic cancers has been reported to be because of differences in pathological features such as size, nodal status and grade (Nagtegaal et al, 2011).…”

Section: Introductionmentioning

confidence: 96%

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Favourable prognostic factors of subsequent screen-detected breast cancers among women aged 50–69

Chiarelli

Edwards

Sheppard

et al. 2012

European Journal of Cancer Prevention

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Most studies reporting more favourable biological features of screen-detected breast cancers compared with symptomatic or interval cancers include initial or prevalent screens and therefore may not indicate the real benefit of screening on breast cancer mortality. We conducted case-case comparisons within a cohort of eligible women (N=771 715) who were aged 50-69 between 1 January 1995 and 31 December 2003. A randomly selected sample of breast cancers (N=1848) diagnosed among these women were compared by detection method. Tumour characteristics of interval cancers (N=362) diagnosed after 6-24 months of a negative screen or symptomatic breast cancers (N=491) were compared with subsequent screen-detected breast cancers diagnosed within 6 months of a positive screen (N=995) using polytomous logistic regression. Tumours were evaluated for clinical presentation, histology and expression of hormone receptors. Women with symptomatic detected [odds ratio (OR)=7.48, 95% confidence interval (CI)=5.38-10.38] and interval cancers (OR=2.20, 95% CI=1.56-3.10) were more often diagnosed at stage III-IV versus I than women with rescreen-detected cancers. After adjusting for tumour size, women with symptomatic cancers had tumours of higher grade (OR=1.50, 95% CI=1.05-2.15) and mitotic score (OR=1.69, 95% CI=1.15-2.49) and women with interval cancers had tumours of higher mitotic score (OR=1.52, 95% CI=1.01-2.28) compared with women diagnosed at screening. Subsequent screen-detected cancers are not only detected at an earlier stage but are also less aggressive, leading to a better prognosis. As long-term mortality reduction for breast screening may depend on subsequent screens, our study indicates that mammography screening can be effective in women aged 50-69.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 96%

See 2 more Smart Citations

Favourable prognostic factors of subsequent screen-detected breast cancers among women aged 50–69

Chiarelli

Edwards

Sheppard

et al. 2012

European Journal of Cancer Prevention

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“…Several studies have demonstrated that the incidence of in situ breast cancer has increased markedly since the adoption of screening mammography, 6,20,21 and cancers detected through screening are approximately twice as likely to be noninvasive as those reported in the general population. 22 Further, community-level mammography rates are positively associated with rates of in situ and local breast cancers. 6 Therefore, because stage at diagnosis is being used as a surrogate measure of mammography utilization in this study, it was particularly important to include in situ stage cases in our sample.…”

Section: Data Sources and Measuresmentioning

confidence: 99%

Characteristics of Mammography Facility Locations and Stage of Breast Cancer at Diagnosis in Chicago

et al. 2008

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In the United States, despite substantial investment in public health initiatives to promote early detection of breast cancer through screening mammography, the proportion of female breast cancers that have advanced beyond the localized stage by the time of diagnosis remains high. Our objective in this exploratory study was to investigate whether stage of breast cancer at diagnosis among Chicago residents is associated with characteristics of the neighborhoods in which proximate mammography facilities are located. Those characteristics may influence likelihood of utilizing the service routinely and partly explain differences in stage at diagnosis. We used a retrospective cohort design and combined 3 years of data from the Illinois State Cancer Registry (ISCR) with information on locations of mammography facilities, public transportation service, crime, and area demographic and economic characteristics. Using a Geographic Information System (GIS), we identified the five facilities located nearest to each case's residence. Estimates of the association between characteristics of mammography facility locations and breast cancer stage at diagnosis were obtained using the partial proportional odds regression model. We found that the number of homicides in areas in which the nearest mammography facilities were located was associated with increased odds of later stage diagnosis. This effect was independent of age, race, and residential area education and income. We found no effect on stage of distance, public transportation service, or measures of neighborhood social similarity. The "spatial dynamics" of health may involve geographies beyond the immediate neighborhood. The results of our study suggest that areas in which the nearest mammography facilities are located may be one such geography. We hope that this study will spark research interest in the impact of health service locations on utilization.

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Impact of familial risk and mammography screening on prognostic indicators of breast disease among women from the Ontario site of the Breast Cancer Family Registry

et al. 2013

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Although several studies have found screen-detected cancers in women with familial breast cancer risk have favorable prognostic features compared with symptomatic cancers, the impact of level of familial risk is unknown. A cohort of 899 first-degree female relatives of cases of breast cancer from the Ontario site of the Breast Cancer Family Registry was followed for 2 years. Logistic regression analyses compared diagnoses of breast cancer or benign breast disease (BBD) between women at high (n = 258, 28.7 %) versus low/moderate (n = 641, 71.3 %) familial risk. Similar analyses compared prognostic features of invasive cancers and BBD by level of familial risk and mammography screening status. Among 899 women, 44 (4.9 %) were diagnosed with invasive breast cancer and/or ductal carcinoma in situ, and 56 (6.2 %) with BBD. Women with high familial risk were significantly more likely to be diagnosed with breast cancer [odds ratio (OR) = 2.84, 95 % confidence interval (CI) 1.50-5.38] than low/moderate risk women, particularly if diagnosed at age ≥50 (OR = 2.99, 95 % CI 1.37-6.56) or screened with mammography (OR = 3.33, 95 % CI 1.54-7.18). High risk women were more likely to be diagnosed with BBD (OR = 1.94, 95 % CI 1.03-3.66). Level of familial risk was not associated with prognostic features. Cancers among unscreened women were larger (OR = 9.72, 95 % CI 1.01-93.61) and diagnosed at stage II or above (OR = 7.80, 95 % CI 1.18-51.50) compared with screen-detected cancers. Screening mammography may be effective for women with a first-degree family history of breast cancer, irrespective of level of familial risk.

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Assessing the effectiveness of a mammography screening service

Abstract: Mammographic detection of breast cancer by BreastScreen WA is associated with reduced breast cancer morbidity and a more favourable prognosis.

Cited by 7 publications

References 32 publications

Favourable prognostic factors of subsequent screen-detected breast cancers among women aged 50–69

Favourable prognostic factors of subsequent screen-detected breast cancers among women aged 50–69

Characteristics of Mammography Facility Locations and Stage of Breast Cancer at Diagnosis in Chicago

Impact of familial risk and mammography screening on prognostic indicators of breast disease among women from the Ontario site of the Breast Cancer Family Registry

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