Non-progressive breast carcinomas detected at mammography screening: a population study

Abstract

Background Some breast carcinomas detected at screening, especially ductal carcinoma in situ, may have limited potential for progression to symptomatic disease. To determine non-progression is a challenge, but if all screening-detected breast tumors eventually reach a clinical stage, the cumulative incidence at a reasonably high age would be similar for women with or without screening, conditional on the women being alive. Methods Using high-quality population data with 24 years of follow-up from the gradually introduced BreastScreen Norway program, we studied whether all breast carcinomas detected at mammography screening 50–69 years of age would progress to clinical symptoms within 85 years of age. First, we estimated the incidence rates of breast carcinomas by age in scenarios with or without screening, based on an extended age-period-cohort incidence model. Next, we estimated the frequency of non-progressive tumors among screening-detected cases, by calculating the difference in the cumulative rate of breast carcinomas between the screening and non-screening scenarios at 85 years of age. Results Among women who attended BreastScreen Norway from the age of 50 to 69 years, we estimated that 1.1% of the participants were diagnosed with a breast carcinoma without the potential to progress to symptomatic disease by 85 years of age. This proportion of potentially non-progressive tumors corresponded to 15.7% [95% CI 3.3, 27.1] of breast carcinomas detected at screening. Conclusions Our findings suggest that nearly one in six breast carcinomas detected at screening may be non-progressive.

Re: Non-progressive breast carcinomas detected at mammography screening: a population study—a model test or a novel test of cancer regression?

“…Heggland and colleagues [ 1 ] have presented a very interesting Norwegian data set and analysed the data using an age-period-cohort model. The authors conclude that nearly one in six breast carcinomas detected at screening may be non-progressive.…”

“…There are numerous studies on the detection rate of previously unscreened women we can use to validate the model by Heggland and colleagues [ 1 ]. When public biennial mammography screening started in Norway in 1996, there were 129 invasive breast tumours among 13,749 women aged 68–69 years in 1996–97, whereof 82 tumours were detected at mammography screening [ 3 ].…”