title: Digital mammography screening in Germany: Impact of age and histological subtype on program sensitivity.
abstract: BACKGROUND
  Program sensitivity (PS), i.e., the ratio of screen-detected cancers divided by the sum of screen-detected plus interval cancers, is a major outcome in population-based mammography screening programs (MSP). This study evaluated PS within the digital MSP in Germany focussing on the impact of age and histological subtype.
  
  
  METHODS
  Data of 838,579 first-time participants aged 50-69 years who were screened in 2005-2008 were linked with cancer registry data from Germany's most populous state, North Rhine-Westphalia. Invasive breast cancers and ductal carcinomas in situ (DCIS) were detected either at screening or during the 24 month post-screening interval. PS was evaluated with respect to age at screening, in-situ or invasive cancer and histological characteristics.
  
  
  RESULTS
  In total, 6767 cancers were detected at screening and 1884 cancers were diagnosed during the post-screening interval. The overall PS amounted to 78.2% and increased from 72.1% at age 50-54 years to 82.4% at age 65-69 years (p for trend <0.0001). PS was higher for non-lobular (79.1%) than lobular carcinomas (72.1%, p < 0.0001). The highest PS was observed in DCIS across all ages (>90%), while PS was lowest among participants aged 50-54 years with invasive breast cancer (67.7%), particularly among those with lobular subtype (62.8%). Interval cancers showed generally more advanced tumour stages.
  
  
  CONCLUSIONS
  While overall PS was high, differences across subgroups indicated that youngest screening participants are at higher risk of interval cancer. Age-adapted recall and assessment strategies in younger participants may need to be considered to improve PS in younger women.
authors: Epidemiological Cancer Registry North Rhine-Westphalia, Münster, Germany. Electronic address: Oliver.Heidinger@krebsregister.nrw.de.
authors: Oliver
authors: O
authors: Heidinger
authors: Epidemiological Cancer Registry North Rhine-Westphalia, Münster, Germany.
authors: Jan
authors: J
authors: Heidrich
authors: Epidemiological Cancer Registry North Rhine-Westphalia, Münster, Germany.
authors: Wolf Ulrich
authors: WU
authors: Batzler
authors: Epidemiological Cancer Registry North Rhine-Westphalia, Münster, Germany.
authors: Volker
authors: V
authors: Krieg
authors: Department of Clinical Radiology and Reference Center for Mammography, Faculty of Medicine, University Hospital Münster, Germany.
authors: Stefanie
authors: S
authors: Weigel
authors: Department of Clinical Radiology and Reference Center for Mammography, Faculty of Medicine, University Hospital Münster, Germany.
authors: Walter
authors: W
authors: Heindel
authors: Epidemiological Cancer Registry North Rhine-Westphalia, Münster, Germany; Institute of Epidemiology and Social Medicine, Faculty of Medicine, University of Münster, Germany.
authors: Hans-Werner
authors: HW
authors: Hense
mesh_terms: D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000453:epidemiology; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008327:Mammography / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D015397:Program Evaluation / Q000706:statistics & numerical data*; D012042:Registries; D012680:Sensitivity and Specificity
keywords: Breast cancer; Cancer registry; Digital mammography screening; Germany; Interval cancer; Program sensitivity