Changes in incidence of and mortality from breast cancer in England and Wales since introduction of screening

Quinn, Mike; Allen, Elizabeth

doi:10.1136/bmj.311.7017.1391

Cited by 156 publications

(105 citation statements)

References 30 publications

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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: 94%

“…Decreases in breast cancer mortality have been variously reported following the introduction of mammographic screening on a regional level (Tornberg et al, 1994;Quinn and Allen, 1995;Garne et al, 1997;Barchielli and Paci, 2001;Broeders et al, 2001;Tabar et al, 2001;Duffy et al, 2002). Randomised prospective trials indicate that benefits in terms of cumulative breast cancer mortality start to emerge 4 -10 years after randomisation (Nyström et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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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“…To investigate their variation across the nine English regions, several potential covariates were considered, in line with other studies (Quinn and Allen, 1995;Schrijvers et al, 1995;Coleman et al, 1999). These were all defined at the HA level and referred to either summary statistics of patient characteristics (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, part of the unexplained geographical variation in survival rates may be due to differences in health care, such as the timing and extent of initial investigation, or type and departures from treatment guidelines (Quinn and Allen, 1995), or to individual level variables, such as the extent of disease at diagnosis (e.g. tumour grade and stage).…”

Section: Discussionmentioning

confidence: 99%

Geographical variation in breast cancer survival rates for women diagnosed in England between 1992 and 1994

et al. 2004

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The 5-year relative survival rates of women diagnosed with breast cancer between 1992 and 1994 were compared among the 99 Health Authorities (1999 boundaries) of England. Substantial variation, with evidence of geographical clustering was observed. Part of this variation was explained by differences in deprivation between Health Authorities, in particular by the percentage of class IV and V households.

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“…Various studies described an increase in breast cancer incidence rates in the last two to three decades for both, situations with and without organised mammography screening (Quinn and Allen, 1995;Chu et al, 1996;McCann et al, 1998;Kricker et al, 1999;Paci et al, 2002;Schouten et al, 2002;Botha et al, 2003;Buiatti et al, 2003). Where organised screening has been introduced, this increase is more marked, mainly as a result of the additional detection of early breast cancer stages.…”

Section: %mentioning

confidence: 99%

Decreased rates of advanced breast cancer due to mammography screening in The Netherlands

et al. 2004

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The effect of the implementation of the Dutch breast cancer screening programme during 1990 -1997 on the incidence rates of breast cancer, particularly advanced breast cancer, was analysed according to stage at diagnosis in seven regions, where no screening took place before 1990. The Netherlands Cancer Registry provided detailed data on breast cancer incidence in 1989 -1997 by tumour stage, age and region. Annual age-adjusted incidence rates of all breast cancers and advanced cancers, defined as large tumours T2 þ with lymph node and/or distant metastases, were compared with rates in 1989. In general, breast cancer incidence rose strongly in the early 1990s, especially in the age category 50 -69 years (estimated annual percentage change (EAPC) 4.25; 95% CI 1.70, 6.86). The increase was mainly due to the increase in small T1 cancers and ductal carcinoma in situ. However, in women aged 50 -69, advanced cancer incidence rates showed a significant decline by 12.1% in 1997 compared with 1989 (EAPC -2.14, 95% CI À3.47, À0.80), followed by a breast cancer mortality reduction of similar size after approximately 2 years. We confirm that breast cancer screening initially leads to a temporary strong increase in the breast cancer incidence, which is followed by a significant decrease in advanced diseases in the women invited for screening. It is evident that breast cancer screening contributes to a reduction in advanced breast cancers and breast cancer mortality.

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Changes in incidence of and mortality from breast cancer in England and Wales since introduction of screening

Cited by 156 publications

References 30 publications

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

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

Geographical variation in breast cancer survival rates for women diagnosed in England between 1992 and 1994

Decreased rates of advanced breast cancer due to mammography screening in The Netherlands

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