Immediate and delayed effects of mammographic screening on breast cancer mortality and incidence in birth cohorts

Ripping, Theodora M.; Verbeek, A.L.M.; Waal, Daniëlle van der; Otten, J.D.M.; Heeten, Gerard J. den; Fracheboud, Jacques; Koning, Harry J. de; Broeders, Mireille J. M.

doi:10.1038/bjc.2013.627

Cited by 8 publications

(6 citation statements)

References 24 publications

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“…This study resulted in an overdiagnosis estimate of 11%, which is comparable with our overdiagnosis estimate of 10–17% at a period in time (result not presented), i.e ., 5‐year periods. A major strength of our study is, however, that we estimated overdiagnosis in birth cohorts, thereby estimating overdiagnosis from the increase in breast cancer incidence during screening and the drop in incidence after leaving screening in the same women and preventing overestimation of overdiagnosis …”

Section: Discussionmentioning

confidence: 99%

“…Until now, such an APC‐model has been used only once to estimate overdiagnosis at a period in time . Overdiagnosis estimates at a period in time have, however, as major disadvantage that they do not study the increase in breast cancer incidence during screening and the drop in incidence after leaving screening in the same women thereby overestimating overdiagnosis . This disadvantage can be overcome by studying overdiagnosis in birth cohorts, i.e ., following the same women over time.…”

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confidence: 99%

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Overdiagnosis by mammographic screening for breast cancer studied in birth cohorts in The Netherlands

et al. 2015

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A drawback of early detection of breast cancer through mammographic screening is the diagnosis of breast cancers that would never have become clinically detected. This phenomenon, called overdiagnosis, is ideally quantified from the breast cancer incidence of screened and unscreened cohorts of women with follow-up until death. Such cohorts do not exist, requiring other methods to estimate overdiagnosis. We are the first to quantify overdiagnosis from invasive breast cancer and ductal carcinoma in situ (DCIS) in birth cohorts using an age-period-cohort -model (APC-model) including variables for the initial and subsequent screening rounds and a 5-year period after leaving screening. Data on the female population and breast cancer incidence were obtained from Statistics Netherlands, "Stichting Medische registratie" and the Dutch Cancer Registry for women aged 0-99 years. Data on screening participation was obtained from the five regional screening organizations. Overdiagnosis was calculated from the excess breast cancer incidence in the screened group divided by the breast cancer incidence in presence of screening for women aged 20-99 years (population perspective) and for women in the screened-age range (individual perspective). Overdiagnosis of invasive breast cancer was 11% from the population perspective and 17% from the invited women perspective in birth cohorts screened from age 49 to 74. For invasive breast cancer and DCIS together, overdiagnosis was 14% from population perspective and 22% from invited women perspective. A major strength of an APC-model including the different phases of screening is that it allows to estimate overdiagnosis in birth cohorts, thereby preventing overestimation.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Overdiagnosis by mammographic screening for breast cancer studied in birth cohorts in The Netherlands

et al. 2015

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“…Nonetheless, despite the lack of data on breast cancer incidence or hormonal therapy in our study population, our finding could contribute to explain, at least partially, the birth cohort effect on the increasing breast cancer incidence observed in the Netherlands across the 1938–1962 birth cohorts, as well as in the UK, Spain and France …”

Section: Discussionmentioning

confidence: 80%

Change in mammographic density across birth cohorts of Dutch breast cancer screening participants

Napolitano

Lynge

Lillholm

et al. 2019

Intl Journal of Cancer

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High mammographic density is a well‐known risk factor for breast cancer. This study aimed to search for a possible birth cohort effect on mammographic density, which might contribute to explain the increasing breast cancer incidence. We separately analyzed left and right breast density of Dutch women from a 13‐year period (2003–2016) in the breast cancer screening programme. First, we analyzed age‐specific changes in average percent dense volume (PDV) across birth cohorts. A linear regression analysis (PDV vs. year of birth) indicated a small but statistically significant increase in women of: 1) age 50 and born from 1952 to 1966 (left, slope = 0.04, p = 0.003; right, slope = 0.09, p < 0.0001); 2) age 55 and born from 1948 to 1961 (right, slope = 0.04, p = 0.01); and 3) age 70 and born from 1933 to 1946 (right, slope = 0.05, p = 0.002). A decrease of total breast volume seemed to explain the increase in PDV. Second, we compared proportion of women with dense breast in women born in 1946–1953 and 1959–1966, and observed a statistical significant increase of proportion of highly dense breast in later born women, in the 51 to 55 age‐groups for the left breast (around a 20% increase in each age‐group), and in the 50 to 56 age‐groups for the right breast (increase ranging from 27% to 48%). The study indicated a slight increase in mammography density across birth cohorts, most pronounced for women in their early 50s, and more marked for the right than for the left breast.

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“…Previous research on the Dutch screening program, which began in 1989, showed that uninvited cohorts experienced a continuous increase in mortality with age, while invited cohorts presented a diverging trend within five years after screening invitation. 27 Afterward, mortality rates started to rise again, although at a lower rate than in uninvited cohorts. 27 In Lithuania, the pattern of BC mortality is very similar to Estonia, showing a major decrease since 1996.…”

Section: Discussionmentioning

confidence: 97%

Incidence-Based Breast Cancer Mortality Trends in Estonia Before and After the Introduction of Organized Mammography Screening: A Register-Based Study

Baburin,

Veerus,

Lang

et al. 2024

Cancer Control

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Background Despite the relatively low breast cancer incidence in Estonia, mortality remains high, and participation in mammography screening is below the recommended 70%. The objective of this register-based study was to evaluate incidence-based (IB) breast cancer mortality before and after the introduction of organized mammography screening in 2004. Methods Breast cancer deaths individually linked to breast cancer diagnosis were obtained from the Estonian Cancer Registry and used for calculating IB mortality. We compared age-specific IB mortality rates across 5-year birth cohorts and 5-year periods. Poisson regression was used to compare IB mortality for one age group invited to screening (50-63) and three age groups not invited to screening (30-49, 65-69, and 70+) during two periods before and after screening initiation (1993-2003 and 2004-2014). Joinpoint regression was used for age-standardized incidence and IB mortality trends. Results Age-standardized IB mortality has been decreasing since 1997. Age-specific IB mortality for birth cohorts never exposed to screening showed a continuous increase with age, while in cohorts exposed to organized screening the mortality curve flattened or declined after the age of first invitation. Significant decreases in mortality from 1993-2003 to 2004-2014 were seen in the 30-49 (age-adjusted rate ratio 0.51, 95% CI 90.42-0.63) and 50-63 (0.65, 95% CI 0.56-0.74) age groups, while no decline was seen in the 65-69 and 70+ age groups. Conclusions The age specific IB mortality curves in birth cohorts exposed to screening and the significant mortality decline in the target age group after the initiation of the organized program suggest a beneficial effect of screening. Improved treatment without screening has not reduced mortality in older age groups. Our results support raising the upper screening age limit to 74 years.

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Immediate and delayed effects of mammographic screening on breast cancer mortality and incidence in birth cohorts

Cited by 8 publications

References 24 publications

Overdiagnosis by mammographic screening for breast cancer studied in birth cohorts in The Netherlands

Overdiagnosis by mammographic screening for breast cancer studied in birth cohorts in The Netherlands

Change in mammographic density across birth cohorts of Dutch breast cancer screening participants

Incidence-Based Breast Cancer Mortality Trends in Estonia Before and After the Introduction of Organized Mammography Screening: A Register-Based Study

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