Effect of implementation of the mass breast cancer screening programme in older women in the Netherlands: population based study

Abstract

Objective To assess the incidence of early stage and advanced stage breast cancer before and after the implementation of mass screening in women aged 70-75 years in the Netherlands in 1998.Design Prospective nationwide population based study.Setting National cancer registry, the Netherlands.Participants Patients aged 70-75 years with a diagnosis of invasive or ductal carcinoma in situ breast cancer between 1995 and 2011 (n=25 414). Incidence rates were calculated using population data from Statistics Netherlands.Main outcome measure Incidence rates of early stage (I, II, or ductal carcinoma in situ) and advanced stage (III and IV) breast cancer before and after implementation of screening. Hypotheses were formulated before data collection.Results The incidence of early stage tumours significantly increased after the extension for implementation of screening (248.7 cases per 100 000 women before screening up to 362.9 cases per 100 000 women after implementation of screening, incidence rate ratio 1.46, 95% confidence interval 1.40 to 1.52, P<0.001). However, the incidence of advanced stage breast cancers decreased to a far lesser extent (58.6 cases per 100 000 women before screening to 51.8 cases per 100 000 women after implementation of screening, incidence rate ratio 0.88, 0.81 to 0.97, P<0.001).Conclusions The extension of the upper age limit to 75 years has only led to a small decrease in incidence of advanced stage breast cancer, while that of early stage tumours has strongly increased.

Cost of extending the NHS breast screening age range in England

“…The risk of developing breast cancer increases with age. In 2014 a prospective nationwide population based study of breast cancer screening in women aged 69-75 in the Netherlands reported a steep rise in the numbers of “early” cancers in the screened group, without significantly reducing numbers of advanced cancer cases 21. Effectively, screening was leading to many more older women “living with cancer,” with little effect on actual deaths from breast cancer.…”

Cancer screening for older people: to screen or not to screen

“…5 Of note, 33 countries have joined the International Cancer Screening Network and are participating in active population-based screening programmes for breast, colorectal, cervical, and lung cancers. 6 There are practice guidelines recommending the ages at which to start screening for various types of cancer, but there is less information about when Searches were conducted for studies in which the population was restricted to those aged 65 years or above.…”

“…Similarly, the benefits of screening were found to be limited due to a huge number of cases of over-diagnosis in the older population. 5 Mandelblatt et al 42 evaluated the effectiveness of 20 different mammography screening programmes using six established models of cancer incidence and mortality trends in the US. They reported that Annual screening based on age and smoking history in the NLST was inefficient; screening up to ages 80 or 85 years would be more efficient if the age of cessation was set at after 69 years, the reduction in mortality would be slight.…”

Overdiagnosis in mammography screening: a 45 year journey from shadowy idea to acknowledged reality

“…Furthermore, the extension of the upper age limit to 75 years for mammography screening in the Netherlands has led to a smaller than expected decrease in advanced breast cancer, while the incidence of early breast cancer strongly increased (figure⇓). 23 DCIS has long been considered a precursor lesion for invasive breast cancer, and mammography has proved highly effective at finding it. Kerlikowske showed a 500% increase in incidence of DCIS among women over 50 between 1983 and 2003.…”

“…Extending screening to women in their 70s has been shown to significantly increase the incidence of early stage breast cancer, 23 and this could have detrimental effects for older women. The risk of overdiagnosis and overtreatment of breast cancer is influenced by competing mortality risks, which increase with age.…”