Age-period-cohort modelling of breast cancer incidence in the Nordic countries

Rostgaard, Klaus; Væth, Michael; Holst, Helle; Madsen, Mette; Lynge, Elsebeth

doi:10.1002/1097-0258(20010115)20:1<47::aid-sim613>3.0.co;2-5

Cited by 33 publications

(24 citation statements)

References 23 publications

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“…This would have led to some of the period effects that were found. The period effects shown in Table 4 reflect changes that affect all age cohorts at a given time and apart from under-reporting in the earliest periods may be due to changes related to health services and breast cancer detection (Rostgaard et al, 2001).…”

Section: Discussionmentioning

confidence: 99%

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Trends in breast cancer incidence in Hong Kong between 1973 and 1999: an age-period-cohort analysis

et al. 2002

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Hong Kong has the highest breast cancer incidence in Asia and studying secular changes in its rates may lead to hypotheses regarding disease aetiology and also predictions of future trends for China. We examined statistics from the Hong Kong Cancer Registry based on 26 566 cases of invasive breast cancer from 1973 to 1999. The trends in breast cancer incidence were studied using log-linear longitudinal models. We further analysed the independent effects of chronological age, time period and birth cohort on incidence trends using age-period-cohort modelling. The average annual per cent change of the age-standardised incidence was 3.6% during 1973 -1999. Age-period-cohort modelling indicated the incidence development was predominantly a cohort effect, where the rise in relative risk was seemingly linear in successive birth cohorts, showing a 2 -3-fold difference when comparing women born in the 1960's with those born around 1900. Our results suggest that direct and indirect consequences of westernisation may have been responsible for most of the observed increase in breast cancer incidence. As China moves towards a more westernised way of life, we can expect an emerging epidemic of breast cancer as Hong Kong's experience has demonstrated.

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Section: Discussionmentioning

confidence: 99%

“…It is well known that increased cancer detection activities, notably mammographic screening examinations, may enhance incidence rates (Persson et al, 1993;Wun et al, 1995;Rostgaard et al, 2001). Hong Kong, however, has never had an organised screening programme.…”

Section: Discussionmentioning

confidence: 99%

Trends in breast cancer incidence in Hong Kong between 1973 and 1999: an age-period-cohort analysis

et al. 2002

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“…The significant increase in incidence recorded only in the LS area (of 14.2%), particularly in women aged 55 -64 years (21.0%), could be explained by earlier detection. Increases in incidence have been recorded in other Western countries in relation to screening (Quinn and Allen, 1995;Garne et al, 1997;Persson et al, 1998;Chu et al, 1996;Rostgaard et al, 2001). In the ES area, no significant increase in incidence was detected.…”

Section: Discussionmentioning

confidence: 95%

Breast cancer mortality trends in two areas of the province of Florence, Italy, where screening programmes started in the 1970s and 1990s

et al. 2004

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We compared breast cancer mortality rates in the period 1985 -2000 in two areas of the province of Florence, Italy, where breast cancer screening programmes started in the 1970s (early screening (ES) area) and in 1990s (late screening (LS) area). The overall age-standardised mortality decreased in the whole period by 40.9% in the ES area (Po0.001), and by 11.3% in the LS area (P ¼ 0.030). Significant decreases in the ES area were detected in groups aged 45 -54 years (61.1%; P ¼ 0.018) and 65 -74 years (44.7%; P ¼ 0.049), whereas in the LS area no significant decrease was detected in any age group. The relatively low compliance in the first years of the programme in both areas, and the long enrolment period in the LS area could have reduced the effect on mortality. Our findings suggest that the drop in mortality in the ES area (41%) could be explained by both service screening and better care. The slight decrease in mortality in the LS area (11%) could be mainly due to better care. A reduction of about 30% is attributable to screening in the ES area over the period 1985 -2000. Mammographic screening has been shown to reduce breast cancer mortality rates (Vainio and Bianchini, 2002). Several studies in northern European countries (Hermon and Beral, 1996;Hakama et al, 1997; Van den Akker-van Marle et al, 1999;Blanks et al, 2000;Jonsson et al, 2001;Botha et al, 2003;Otto et al, 2003;Tabar et al, 2003) have reported a decrease in breast cancer mortality where nationwide screening programmes have been implemented. There has, however, been considerable debate concerning the relative contributions of screening and of improved therapy to the observed trends (Carnon et al, 1996;Blanks et al, 2000;Peto et al, 2000).At the beginning of the 1970s in 23 rural municipalities of the province of Florence, Italy (early screening area (ES area) among about 70 000 resident women aged 25 or over, 18% of women of the province, based on 1991 Census), a mammographic screening programme was started; until 1989, women in the 40 -69 year age group were invited, whereas from that year onwards the target population was restricted to age group 50 -69 years. The number of mammograms performed in the ES area was 8000 -9000 per year. The efficacy of the programme on breast cancer mortality in the ES area has been evaluated for the period 1977 -1984 by means of case -control studies (Palli et al, 1986(Palli et al, , 1989, and by using early indicators of efficacy (Paci et al, 1990). After 1990, when the screening for women aged 50 -69 years started in the rest of the province, including the city of Florence (late screening area: LS area), the number of mammograms in the whole province increased to 28 000 -29 000 per year (Barchielli et al, 1999).In this study, we have compared breast cancer mortality rates in the period 1985 -2000 in the ES and LS areas. MATERIALS AND METHODS Sources of data Statistical analysisAdjusted mortality and incidence rates using direct standardisation to the European Standard Population, and age-specific (35 -44, 45 -...

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“…[1][2][3][4][5][6][7][8][9][10] There is, however, a little information on how the separate phases of an invitational program differ from each other in terms of influencing the incidence. [1][2][3] It is also reasonable to assume that the impact of different program phases on breast cancer incidence is dependent on women's age and stage of cancer, which are issues that have, to our knowledge, never been studied jointly before.…”

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confidence: 99%

Effects of different phases of an invitational screening program on breast cancer incidence

Seppänen

Heinävaara

Anttila

et al. 2006

Intl Journal of Cancer

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The aim of this study was to quantify the effects of separate phases of an invitational screening program on breast cancer incidence at different ages. Our database included detailed municipality-specific information about invitations for mass-screening for breast cancer in 267 Finnish municipalities from time period 1987-2001. The age range was 50-74. For this study, the program was divided into 7 separate phases, and those that had not been invited served as a baseline. The incidence rate was modeled using Poisson regression. To study the differences between age groups within each program phase, an interaction term between age group and phase of screening was included in the model. The modeling was done separately for localized breast cancers, nonlocalized breast cancers and all stages combined. For localized cancers, the risk compared to the noninvited increased during the first years of the 2-year screening rounds in all age groups, and declined below the baseline during the second years. This effect was larger during the first round compared to the subsequent ones. In nonlocalized cancers, a clear incidence peak was detected only during the first year of the first round. A decreasing post screening effect was detected in nonlocalized cancers in women aged 60-69, but not in localized cancers. Cumulating over ages 50-74, extra incidence caused by regular screening in localized cancers was 5.2% if the program was continued up to age 59, and 28.0% if it continued up to age 69. Corresponding figures for nonlocalized cancers were decreases of 19.8% and 20.9%, respectively. ' 2006 Wiley-Liss, Inc.Key words: incidence; breast cancer; mass-screening; mammography Regular mass-screening has been shown to have an impact on breast cancer incidence. [1][2][3][4][5][6][7][8][9][10] There is, however, a little information on how the separate phases of an invitational program differ from each other in terms of influencing the incidence. 1-3 It is also reasonable to assume that the impact of different program phases on breast cancer incidence is dependent on women's age and stage of cancer, which are issues that have, to our knowledge, never been studied jointly before.Møller et al. have estimated the influence of invitational screening program phases on breast cancer incidence by assuming that each municipality within a country follows the same, fixed massscreening pattern given by official recommendations. 1,2 In the study of Jonsson et al., starting times, age range and screening intervals of the included programs were collected by a questionnaire. 3 Our access to a database that includes actual year-and agespecific screening invitation information from Finnish municipalities makes it possible to take into account the real patterns of screening in the municipalities. It also makes it possible to study and code adequately the different phases of the 2-year massscreening cycle and to separate the years within a screening round from each other. As a result, we expect more accurate and detailed information about the impacts o...

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Age-period-cohort modelling of breast cancer incidence in the Nordic countries

Cited by 33 publications

References 23 publications

Trends in breast cancer incidence in Hong Kong between 1973 and 1999: an age-period-cohort analysis

Trends in breast cancer incidence in Hong Kong between 1973 and 1999: an age-period-cohort analysis

Breast cancer mortality trends in two areas of the province of Florence, Italy, where screening programmes started in the 1970s and 1990s

Effects of different phases of an invitational screening program on breast cancer incidence

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