Comparison between opportunistic and organised breast cancer mammography screening in the Swiss canton of Fribourg

Abstract

Background Breast cancer screening mammography is widespread in industrialised countries within the framework of public health program or opportunist form. Only few data exist on the comparison of effectiveness between organised and opportunistic screening. The aim of this study is to compare organised and opportunistic screening using population-based data from the Fribourg cancer registry, Switzerland. Methods We included all first primary breast adenocarcinoma diagnosed between 2006 and 2014 in women aged 50–69 years resident in the canton of Fribourg. We considered only breast cancer discovered by mammography screening. We compared patients, tumour characteristics and treatment modalities between breast cancer detected by the organised screening program versus opportunistic screening using logistic regression. Results Out of 989 patients diagnosed with breast cancer, 402 (40.6%) were diagnosed by organised and 205 (20.7%) by opportunistic screening. Women with breast cancer detected within the screening program were more likely to be from rural areas ( P = 0.035) and lived less frequently in high favoured regions ( P = 0.020). They presented more frequently in situ than invasive cancer ( P = 0.022). For patients with invasive breast cancer, those detected by the program were less likely to undergo mastectomy ( P = 0.06) and consequently, they were more likely to undergo radiation therapy ( P = 0.003). Adjustment for area of residence and financial context of the region did not modify the results presented. Conclusions The present study reports an increased rate of detection of carcinoma in situ in organised screening program as compared to opportunistic screening mammographies, an indirect evidence of a higher radiologic sensitivity. Furthermore, the results show a trend towards more mastectomies among patients with breast cancer discovered after opportunistic than after organized mammography screening, reflecting lower treatment burden. Those results were independent of socio-economic factors which differed across screening groups.

Predictors and Trend in Attendance for Breast Cancer Screening in Lithuania, 2006–2014

“…Our findings on higher rates of having a mammogram among women living in cities compared to villages are in line with other studies [33,34]. However, a study carried out in Korea showed the opposite result: a rural residence was related to higher rates of BC screening attendance [19].…”

Understanding the paradigma of opportunistic screening

“…This study showed a significant difference between the opportunistic screening and diagnostic patients in terms of the axillary involvement (p = 0.009), stage of the cancer (p < 0.001), DCIS detection rate and mean tumor size which are the main benchmarks of a better outcome. A recent study evaluating the opportunistic screening showed its efficacy with a reduced mortality which was comparable to population-based screening outcomes [12]. Although our study does not provide its effect on mortality our screening results are comparable with the populationbased screening of BBCSP and showed significant differences compared to diagnostic patients.…”

“…Compared to BBCSP results we had a relatively lower percentage of stage 0 and 1 cancer but higher than the national data. A recent study showed similar findings with a lower DCIS detection rate in the opportunistic screening group compared to population-based organization [12]. They have explained this difference with a possible more effective evaluation of the mammograms in organized screening programs by specifically trained screening radiologists.…”

Patterns of gynaecological check-up and their association with body mass index within the CONSTANCES cohort

“…It leads to unnecessary expense and is also potentially harmful: use of X-rays for BCS, and unnecessary anxiety and needless treatments for both BCS and CCS. [23][24][25] Obese and overweight women underwent more BCS than CCS, as seen clearly in pattern A. This finding is partly explained by their lower socioeconomic position because BCOS is free in contrast to CCS: the cost of a Pap test is added to the cost of the office visit.…”

“…Overscreening was concentrated in patterns C and D for CCS and in pattern D for BCS (due to the regular use of BCOpS). It leads to unnecessary expense and is also potentially harmful: use of Xrays for BCS, and unnecessary anxiety and needless treatments for both BCS and CCS [23][24][25] .…”