Is the incidence of advanced‐stage breast cancer affected by whether women attend a steady‐state screening program?

Munck, Linda de; Fracheboud, Jacques; Bock, Geertruida H. de; Heeten, Gerard J. den; Siesling, Sabine; Broeders, Mireille J. M.

doi:10.1002/ijc.31388

Cited by 25 publications

(26 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In recent decennia, mammography screening has been introduced in many countries. Studies have shown that screening can detect breast cancer at an earlier stage which will reduce treatment burden and improve survival [ [2] , [3] , [4] ]. However, there are ongoing debates on whether screening does more harm than good and on the related optimization of screening strategy.…”

Section: Introductionmentioning

confidence: 99%

Mammographic sensitivity as a function of tumor size: A novel estimation based on population-based screening data

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background Instead of a single value for mammographic sensitivity, a sensitivity function based on tumor size more realistically reflects mammography’s detection capability. Because previous models may have overestimated size-specific sensitivity, we aimed to provide a novel approach to improve sensitivity estimation as a function of tumor size. Methods Using aggregated data on interval and screen-detected cancers, observed tumor sizes were back-calculated to the time of screening using an exponential tumor growth model and a follow-up time of 4 years. From the observed number of detected cancers and an estimation of the number of false-negative cancers, a model for the sensitivity as a function of tumor size was determined. A univariate sensitivity analysis was conducted by varying follow-up time and tumor volume doubling time (TVDT). A systematic review was conducted for external validation of the sensitivity model. Results Aggregated data of 22,915 screen-detected and 10,670 interval breast cancers from the Dutch screening program were used. The model showed that sensitivity increased from 0 to 85% for tumor sizes from 2 to 20 mm. When TVDT was set at the upper and lower limits of the confidence interval, sensitivity for a 20-mm tumor was 74% and 93%, respectively. The estimated sensitivity gave comparable estimates to those from two of three studies identified by our systematic review. Conclusion Derived from aggregated breast screening outcomes data, our model’s estimation of sensitivity as a function of tumor size may provide a better representation of data observed in screening programs than other models.

show abstract

Section: Introductionmentioning

confidence: 99%

Mammographic sensitivity as a function of tumor size: A novel estimation based on population-based screening data

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…The key benefit of regular mammography screening is that it detects breast cancer at an early stage allowing more effective treatment and improved survival [ 2 ]. A recent study showed that the incidence of early-stage breast cancer in patients who attend screening regularly is significantly higher than that in patients who did not, suggesting a stage shift to earlier detection with the implementation of regular screening [ 3 ]. However, there are also controversies regarding screening.…”

Section: Introductionmentioning

confidence: 99%

The cost-effectiveness of digital breast tomosynthesis in a population breast cancer screening program

et al. 2020

Self Cite

View full text Add to dashboard Cite

Objectives To evaluate at which sensitivity digital breast tomosynthesis (DBT) would become cost-effective compared to digital mammography (DM) in a population breast cancer screening program, given a constant estimate of specificity. Methods In a microsimulation model, the cost-effectiveness of biennial screening for women aged 50–75 was simulated for three scenarios: DBT for women with dense breasts and DM for women with fatty breasts (scenario 1), DBT for the whole population (scenario 2) or maintaining DM screening (reference). For DM, sensitivity was varied depending on breast density from 65 to 87%, and for DBT from 65 to 100%. The specificity was set at 96.5% for both DM and DBT. Direct medical costs were considered, including screening, biopsy and treatment costs. Scenarios were considered to be cost-effective if the incremental cost-effectiveness ratio (ICER) was below €20,000 per life year gain (LYG). Results For both scenarios, the ICER was more favourable at increasing DBT sensitivity. Compared with DM screening, 0.8–10.2% more LYGs were found when DBT sensitivity was at least 75% for scenario 1, and 4.7–18.7% when DBT sensitivity was at least 80% for scenario 2. At €96 per DBT, scenario 1 was cost-effective at a DBT sensitivity of at least 90%, and at least 95% for scenario 2. At €80 per DBT, these values decreased to 80% and 90%, respectively. Conclusion DBT is more likely to be a cost-effective alternative to mammography in women with dense breasts. Whether DBT could be cost-effective in a general population highly depends on DBT costs. Key Points • DBT could be a cost-effective screening modality for women with dense breasts when its sensitivity is at least 90% at a maximum cost per screen of €96. • DBT has the potential to be cost-effective for screening all women when sensitivity is at least 90% at a maximum cost per screen of €80. • Whether DBT could be used as an alternative to mammography for screening all women is highly dependent on the cost of DBT per screen.

show abstract

“…The present study had individual data available for a large cohort of women who regularly responded to three of the biennial invitations of the Germen MSP. It differs from previous study with individual data [4][5][6][7] in that it employedto our knowledge for the first time -the methods suggested by the EU guidelines: the ABC incidence in a cohort of regular screening participants was compared with the reference incidence of ABC in the period prior to the start of the MSP.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, despite large methodological differences (e.g., definition of ABC, definition of screening attender, duration of follow-up, etc. ), all five studies observed reductions in the ABC incidence of screening attenders compared to non-attenders [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 93%

“…The reduction in the incidence of advanced breast cancer (ABC) is probably the most informative surrogate indicator for the breast cancer mortality decline that may be expected from an organized mammography screening program [1][2][3]. Numerous observational studies, investigating routine screening programs in various populations, have produced rather inconsistent findings with regard to the changes of ABC incidence observable in the course of the different programs [4][5][6][7][8][9][10][11][12][13]. The majority of these studies assessed changes of ABC incidence rates based on aggregated population data because they had no access to individual information on screening history and diagnoses.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence of advanced-stage breast cancer in regular participants of a mammography screening program: a prospective register-based study

Khil¹,

Heidrich²,

Wellmann³

et al. 2020

BMC Cancer

View full text Add to dashboard Cite

Background: The European Guidelines for breast cancer screening suggest that the impact of population-based mammography screening programmes (MSP) may be assessed using the relative reduction in the incidence of advanced breast cancer (ABC, that is, stage UICC II and higher) as a surrogate indicator of screening effectiveness.Methods: This prospective, population register-based study contained individual data of 1,200,246 women (aged 50-69 years) who attended the initial prevalence screening between 2005 and 2009. Of them, 498,029 women returned for the regular (i.e., within 24 months) first subsequent, and 208,561 for the regular second subsequent incidence screenings. The incidence rate of ABC was calculated for the 24-months period following, but not including, the initial screening by incorporating all interval ABCs and all ABCs detected at the regular first incidence screening; the ABC rate for the second 24-months period was determined in the same way, including ABCs detected in the interval after the first and, respectively, at the second incidence screening. The relative reduction in the ABC incidence was derived by comparing the age-standardized rates in these two periods with an agestandardized reference incidence rate, observed in the target population before the MSP implementation. The strengths and weaknesses of this particular study design were contrasted with a recently published checklist of main methodological problems affecting studies of the effect of MSP on ABC incidence.Results: The age-standardized ABC incidence rate was 291.6 per 100,000 women for the 24-months period subsequent to the initial screening, and 275.0/100,000 for the 24-months period following the first subsequent screening. Compared to the 2-year incidence of 349.4/100,000 before the start of the MSP, this amounted to a relative reduction of 16.5 and 21.3%, respectively, in the incidence of ABC among regular MSP participants. Conclusions:The design employed in this study avoids some of the substantial methodological limitations that compromised previous observational studies. Nevertheless, specific limitations prevail that demand a cautious interpretation of the results. Therefore, the study findings, indicating a reduction in ABC for regular MSP participants, need to be followed with respect to potential impacts on breast cancer mortality rates.

show abstract

Is the incidence of advanced‐stage breast cancer affected by whether women attend a steady‐state screening program?

Cited by 25 publications

References 45 publications

Mammographic sensitivity as a function of tumor size: A novel estimation based on population-based screening data

Mammographic sensitivity as a function of tumor size: A novel estimation based on population-based screening data

The cost-effectiveness of digital breast tomosynthesis in a population breast cancer screening program

Incidence of advanced-stage breast cancer in regular participants of a mammography screening program: a prospective register-based study

Contact Info

Product

Resources

About