Mammography screening is associated with more favourable breast cancer tumour characteristics and better overall survival: case-only analysis of 3739 Asian breast cancer patients

Abstract

Background Early detection of breast cancer (BC) through mammography screening (MAM) is known to reduce mortality. We examined the differential effect that mammography has on BC characteristics and overall survival and the sociodemographic determinants of MAM utilization in a multi-ethnic Asian population. Methods This study included 3739 BC patients from the Singapore Breast Cancer Cohort (2010–2018). Self-reported sociodemographic characteristics were collected using a structured questionnaire. Clinical data were obtained through medical records. Patients were classified as screeners (last screening mammogram ≤ 2 years before diagnosis), non-screeners (aware but did not attend or last screen > 2years), and those unaware of MAM. Associations between MAM behaviour (MB) and sociodemographic factors and MB and tumour characteristics were examined using multinomial regression. Ten-year overall survival was modelled using Cox regression. Results Patients unaware of screening were more likely diagnosed with late stage (ORstage III vs stage I (Ref) [95% CI]: 4.94 [3.45–7.07], p < 0.001), high grade (ORpoorly vs well-differentiated (reference): 1.53 [1.06–2.20], p = 0.022), nodal-positive, large size (OR>5cm vs ≤2cm (reference): 5.06 [3.10–8.25], p < 0.001), and HER2-positive tumours (ORHER2-negative vs HER2-positive (reference): 0.72 [0.53–0.97], p = 0.028). Similar trends were observed between screeners and non-screeners with smaller effect sizes. Overall survival was significantly shorter than screeners in the both groups (HRnon-screeners: 1.89 [1.22–2.94], p = 0.005; HRunaware: 2.90 [1.69–4.98], p < 0.001). Non-screeners and those unaware were less health conscious, older, of Malay ethnicity, less highly educated, of lower socioeconomic status, more frequently ever smokers, and less physically active. Among screeners, there were more reported personal histories of benign breast surgeries or gynaecological conditions and positive family history of breast cancer. Conclusions Mammography attendance is associated with more favourable BC characteristics and overall survival. Disparities in the utility of MAM services suggest that different strategies may be needed to improve MAM uptake.

“It Will Lead You to Make Better Decisions about Your Health”—A Focus Group and Survey Study on Women’s Attitudes towards Risk-Based Breast Cancer Screening and Personalised Risk Assessments

“…Singapore is the first country in Asia to launch a widespread, population-based organised mammography screening programme in 2002 [ 6 ]. However, the consistently low participation rate (<40%) is far from the ideal minimum of 70% required to see substantial mortality reduction benefits [ 7 , 8 , 35 ]. Our eight focus group discussions eliciting opinions from 54 women without a history of breast cancer revealed no novel barriers and motivations to attending screening mammography in Singapore.…”

“…Our eight focus group discussions eliciting opinions from 54 women without a history of breast cancer revealed no novel barriers and motivations to attending screening mammography in Singapore. Misconceptions about screening, lack of perceived breast cancer risk, perceived efficacy of mammography to save lives, physical discomfort, cost, inconvenience, fatalism, fear, support and encouragement from family members are reiterated considerations [ 9 , 35 , 36 , 37 , 38 , 39 ].…”

“…In another work, Yabroff et al reported that these behavioural strategies (i.e., “strategies that alter cues or stimuli associated with screening behaviour”, such as mail or phone reminders to screen) improved screening by 13.2% compared with no intervention in a meta-analysis that included 43 studies in the United States [ 41 ]. Analysing self-reported questionnaire data on mammography screening attendance and attitudes from 3739 breast cancer patients in Singapore, Lim et al revealed various patterns among screeners who have recently undergone mammography screening [ 35 ]. The proportions of screeners who reported being motivated by both innate health consciousness and extrinsic cues, solely by innate health consciousness, solely by extrinsic cues, or a combination of other factors was found to be even (~25% in each group).…”

Breast cancer patients participating in the Swiss mammography screening program "donna" exhibit extended survival

“…To account for these improvements in diagnosis and treatment, updated studies are required using different methodologies, as conducting RCTs for the evaluation of MSPs is nowadays ethically not acceptable. Employing various methodological designs, a series of more recent international studies has shown decreased mortality and less disability for women with BC diagnosed via MSPs [10][11][12]. For Switzerland, Herrmann [7] had found a strong decline of overall BC mortality from 1992 to 2012, but, by comparing cantons with and without MSP, he did not detect signi cant regional differences as an effect of organized MSPs.…”

Breast cancer patients enrolled in the Swiss mammography screening program “donna” demonstrate prolonged survival

“…To account for these improvements in diagnosis and treatment, updated studies are required using different methodologies, as conducting RCTs for the evaluation of MSPs is ethically not acceptable. Employing various methodological designs, a series of more recent international studies has shown decreased mortality and a reduction in disability-adjusted life years for women with BC diagnosed via MSPs [ 10 – 12 ]. For Switzerland, Herrmann [ 7 ] found a strong decline of overall BC mortality from 1992 to 2012, but, by comparing cantons with and without MSP, he did not detect significant regional differences as an effect of organized MSPs.…”