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

Abstract

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 -...

Changes in breast cancer mortality in Navarre (Spain) after introduction of a screening programme

“…20 Reductions in mortality of up to 40% have also been reported in areas of the province of Florence (Italy), where screening started in the 1970s. 21 The screening programme in Navarre was implemented very rapidly. In two years, it covered the entire population, and over time participation rates of more than 85% have been achieved.…”

The Impact of Mammographic Screening on Breast Cancer Mortality in Europe: A Review of Observational Studies

“…31,46,48,52 -55 Of the three studies comparing time periods within a single country, all had adequate follow-up, and the estimates of mortality reduction compared with a prescreening period ranged from 28% to 36%. 41,53,64 IBM studies Table 3 shows the design characteristics of the IBM studies. The outcomes were generally compatible when differences in methodology and local circumstances were taken into account.…”

“…Case-control studies (n ¼ 41 Paci, Eur J Cancer (2002) 42 Puliti, Br J Cancer (2008) 43 Barchielli, Cancer Causes Control (2001) 44 Paci, Br J Cancer (2002) 45 The Netherlands 1989 50-74 Otten, Int J Cancer (2008) 46 Otto, Cancer Epidemiol Biomarkers Prev (2012) 47 Otto, Lancet (2003) 48 van Schoor, Br J Cancer (2011) 15 Paap, Cancer Causes Control (2010) 49 Broeders enrolled in the study only if the breast cancer diagnosis occurred in a certain time/age window (taking into account eligibility and opportunity to be screened) and the population is classified by screening or by invitation to screening. Thus, for example, breast cancer deaths in the 15 years after screening is initiated in one region, from tumours diagnosed in that 15-year period, may be compared with the corresponding deaths from tumours diagnosed in the same period in a region without screening.…”

Role of mammography screening as a predictor of survival in postmenopausal breast cancer patients

“…Several guidelines and different expert groups recommend mammography screening examinations (IARC, 2002) despite the contradicting opinions questioning the positive effect of the screening (Gotzsche and Olsen, 2000). Recent evaluations have shown that service screening may be even more effective than screening in population-based trials Paci et al, 2002;Gorini et al, 2004). Information of actual participation to screening, data of incident cancers and detailed information of tumour characteristics have provided more precise information of breast cancer prognosis in the screened and not-screened patients (Ernst et al, 2004).…”

“…Information of actual participation to screening, data of incident cancers and detailed information of tumour characteristics have provided more precise information of breast cancer prognosis in the screened and not-screened patients (Ernst et al, 2004). Comparison of incident-based breast cancer mortality before and after beginning of screening has shown a significant mortality reduction (Tabar et al, 2003;Gorini et al, 2004).…”