The effect of the Flemish breast cancer screening program on breast cancer-specific mortality: A case-referent study

Troeyer, Katrien De; Silversmit, Geert; Rosskamp, Michael; Truyen, Inge; Herck, Koen Van; Goossens, Mathijs; Martens, Patrick; Kellen, Eliane; Hendrickx, Erik; Rummens, Elise; Smet, Frank De; Broeders, Mireille J. M.; Verdoodt, Freija; Schutter, Harlinde De

doi:10.1016/j.canep.2022.102320

Cited by 7 publications

(8 citation statements)

References 35 publications

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“…RCTs 10,94,97,99,100 reported 0.92 fewer breast cancer deaths per 1,000 and in observational studies values reported 2.68 and 3.17 fewer deaths per 1,000, for case-control 66,80–82,84–86 and cohort studies 47,71,72,74 , respectively. For the observational analysis related to stopping vs. continuing screening, one study 78 reported 0.81 fewer deaths per 1,000 in those who continued screening into their 70s.…”

Section: Resultsmentioning

confidence: 94%

“…72,74 Lastly, two studies did not report average follow-up length and reasons for loss to follow-up were not reported. 72,74 Cases and controls were not age-matched in two studies 66,80 or failed to report adjusting for important confounding factors related to self-selection bias. 66,80–82,84–86 Three case-control studies did not provide screening details or confirm all women were invited to screening.…”

Section: Resultsmentioning

confidence: 99%

“…72,74 Cases and controls were not age-matched in two studies 66,80 or failed to report adjusting for important confounding factors related to self-selection bias. 66,80–82,84–86 Three case-control studies did not provide screening details or confirm all women were invited to screening. 82,84,86 For time-series and ecological studies, there was a lack of reporting on participant characteristics, loss to follow-up and missing data.…”

Section: Resultsmentioning

confidence: 99%

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Screening for breast cancer: A systematic review update to inform the Canadian Task Force on Preventive Health Care guideline

Bennett,

Shaver,

Vyas

et al. 2024

Preprint

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ObjectiveThis systematic review update synthesized recent evidence on the benefits and harms of breast cancer screening in women aged ≥ 40 years and aims to inform the Canadian Task Force on Preventive Health Care’s (CTFPHC) guideline update.MethodsWe searched Ovid MEDLINE® ALL, Embase Classic+Embase, and Cochrane Central Register of Controlled Trials to update our searches to July 8, 2023. Search results for observational studies were limited to publication dates from 2014 to capture more relevant studies. Screening was performed independently and in duplicate by the review team. To expedite the screening process, machine learning was used to prioritize relevant references. Critical health outcomes, as outlined by the CTFPHC, included breast cancer and all-cause mortality, treatment-related morbidity, and overdiagnosis. Randomized controlled trials (RCTs), non/quasi RCTs, and observational studies were included. Data extraction and quality assessment were performed by one reviewer and verified by another. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool for RCTs and the Joanna Brigg’s Institute (JBI) checklists for non-randomized and observational studies. When deemed appropriate, studies were pooled via random-effects models. The overall certainty of the evidence was assessed following GRADE guidance.ResultsThree new papers reporting on existing RCT trial data and 26 observational studies were included. No new RCTs were identified in this update. No study reported results by ethnicity, race, proportion of study population with dense breasts, or socioeconomic status.For breast cancer mortality, RCT data from the prior review reported a significant relative reduction in the risk of breast cancer mortality with screening mammography for a general population of 15% (RR 0.85 95% CI 0.78 to 0.93). In this review update, the breast cancer mortality relative risk reduction based on RCT data remained the same, and absolute effects by age decade over 10 years were 0.27 fewer deaths per 1,000 in those aged 40 to 49; 0.50 fewer deaths per 1,000 in those aged 50 to 59; 0.65 fewer deaths per 1,000 in those aged 60 to 69; and 0.92 fewer deaths per 1,000 in those aged 70 to 74. For observational data, the relative mortality risk reduction ranged from 29% to 62%. Absolute effects from breast cancer mortality over 10 years ranged from 0.79 to 0.94 fewer deaths per 1,000 in those aged 40 to 49; 1.45 to 1.72 fewer deaths per 1,000 in those aged 50 to 59; 1.89 to 2.24 fewer deaths per 1,000 in those aged 60 to 69; and 2.68 to 3.17 fewer deaths per 1,000 in those aged 70 to 74.For all-cause mortality, RCT data from the prior review reported a non-significant relative reduction in the risk of all-cause mortality of screening mammography for a general population of 1% (RR 0.99, 95% CI 0.98 to 1.00). In this review update, the absolute effects for all-cause mortality over 10 years by age decade were 0.13 fewer deaths per 1,000 in those aged 40 to 49; 0.31 fewer deaths per 1,000 in those aged 50 to 59; 0.71 fewer deaths per 1,000 in those aged 60 to 69; and 1.41 fewer deaths per 1,000 in those aged 70 to 74. No observational data were found for all-cause mortality.For overdiagnosis, this review update found the absolute effects for RCT data (range of follow-up between 9 and 15 years) to be 1.95 more invasive and in situ cancers per 1,000, or 1 more invasive cancer per 1,000, for those aged 40 to 49 and 1.93 more invasive and in situ cancers per 1,000, or 1.18 more invasive cancers per 1,000, for those aged 50 to 59. A sensitivity analysis removing high risk of bias studies found 1.57 more invasive and in situ cancers, or 0.49 more invasive cancers, per 1,000 for those aged 40 to 49 and 3.95 more invasive and in situ cancers per 1,000, or 2.81 more invasive cancers per 1,000, in those aged 50 to 59. For observational data, one report (follow-up for 13 years) found 0.34 more invasive and in situ cancers per 1,000 in those aged 50 to 69.Overall, the GRADE certainty of evidence was assessed as low or very low, suggesting that the evidence is very uncertain about the effect of screening for breast cancer on the outcomes evaluated in this review.ConclusionsThis systematic review update did not identify any new trials comparing breast cancer screening to no screening. Although 26 new observational studies were identified, the overall quality of evidence remains generally low or very low. Future research initiatives should prioritize studying screening in higher risk populations such as those from different ages, racial or ethnic groups, with dense breasts, or family history.RegistrationProtocol available on the Open Science Framework:https://osf.io/xngsu/

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Screening for breast cancer: A systematic review update to inform the Canadian Task Force on Preventive Health Care guideline

Bennett,

Shaver,

Vyas

et al. 2024

Preprint

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“… 1 , 2 Recent research showed that attendance in the Flemish PMSP significantly reduces breast cancer-specific mortality compared to ‘routine care’ (opportunistic screening or no screening), which is in line with results from other European studies. 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

The effect of a pre-scheduled appointment on attendance in a population-based mammography screening programme

Goossens

Kellen

Broeders

et al. 2023

European Journal of Public Health

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Background Pre-scheduled appointments can increase attendance in breast cancer screening programmes compared to ‘open invitations’ but relatively few randomized controlled trials exist. We investigated the effect of a pre-scheduled appointment on uptake in the Flemish population-based mammography screening programme. Methods Between September and December 2022, a total of 4798 women were randomly assigned to receive either a pre-scheduled appointment or open invitation. The difference in attendance was compared with Poisson regression analysis for the primary endpoint (attendance ≤92 days after date of invitation), yielding relative risks (RRs). This was done separately for three groups: women invited to a mobile unit and a history of nonattendance (group M-NA); women invited to a hospital-based unit and a history of nonattendance (group HB-NA); women invited to a hospital-based unit and a history of irregular attendance (group HB-IA). There were no women invited to a mobile unit and a history of irregular attendance. Results The RRs in favour of the pre-scheduled appointment were 2.3 [95% confidence interval (CI) 1.80–2.88], 1.8 (95% CI 1.07–2.97) and 1.8 (95% CI 1.43–2.39), for groups M-NA, HB-NA and HB-IA, respectively. We found no statistically significant difference between the various RRs. The respective absolute gains in attendance between pre-scheduled appointment and open invitation were 8.3%, 4.4% and 15.8%. Conclusions Sending an invitation with a pre-scheduled appointment is an effective tool to increase screening attendance in both mobile and hospital-based screening units. The pre-scheduled appointment is associated with a considerable absolute gain in attendance which varies depending on the screening history.

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“…At the highest level of the hierarchy of studies on diagnostic tests, according to a modified Thornbury scale societal impact, entailing a benefit–cost and cost-effectiveness analysis from a societal perspective, is mammography. Indeed, mammography is one of the few radiological tests directly shown to reduce death from breast cancer in randomized controlled trials [ [5] , [6] , [7] ].…”

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confidence: 99%

Towards consensus on managing high mammographic density in population breast screening?

Tagliafico

Houssami

2023

The Breast

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The effect of the Flemish breast cancer screening program on breast cancer-specific mortality: A case-referent study

Cited by 7 publications

References 35 publications

Screening for breast cancer: A systematic review update to inform the Canadian Task Force on Preventive Health Care guideline

Screening for breast cancer: A systematic review update to inform the Canadian Task Force on Preventive Health Care guideline

The effect of a pre-scheduled appointment on attendance in a population-based mammography screening programme

Towards consensus on managing high mammographic density in population breast screening?

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