title: Analysis of the temporal patterns of benefits in the Health Insurance Plan of Greater New York trial by stage and age.
abstract: Reductions in breast cancer mortality in the Health Insurance Plan of Greater New York trial are examined by age at entry and stage at diagnosis using a stage shift cancer screening model. The results indicate that for women aged 40-49 years at entry, benefits are associated with an internal stage shift of stage 1 cancers that have a prognosis poorer than the usual stage 1 cancers. Further, the results indicate that after 18 years of follow-up, of the reduction of 16 fewer deaths in the intervention group, 12-15 of the deaths are related to this internal shift. Given that stage 1 cases inherently have relatively good survival, the time required to see the screening benefit is substantial. For women aged 50-64 years at entry, the results suggest that benefits are associated primarily with shifts to or within stage 1. Further, the results indicate that after 6 years, of the reduction of 31 fewer deaths in the intervention group, 22 of the deaths are related to external shifts to stage 1. Given that stage 2 cancers have poorer survival than stage 1 cancers, screening benefit is seen sooner for the older cohort than for the younger cohort.
authors.affiliation: Early Detection Branch, National Cancer Institute, Bethesda, MD 20892.
authors.forename: K C
authors.initials: KC
authors.lastname: Chu
authors.forename: R J
authors.initials: RJ
authors.lastname: Connor
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008327:Mammography / Q000592:standards; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D015233:Models, Statistical; D009367:Neoplasm Staging; D009519:New York City / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors