Reduction of Advanced Breast Cancer Stages at Subsequent Participation in Mammography Screening.
OBJECTIVE
The decline in advanced breast cancer stages is presumably the most relevant surrogate parameter in mammography screening. It represents the last step in the causal cascade that is expected to affect breast cancer-related mortality. To assess the effectiveness of population-based screening, we analyzed the 2-year incidence rates of advanced breast cancers between women participating in the initial and in the first subsequent round.


METHODS
The study included data from 19,563 initial and 18,034 subsequent examinations of one digital screening unit (2008 - 2010). Data on tumor stages, detected by screening or within the following interval of two years (2-year incidence), were provided by the epidemiological cancer registry. Rates of all and combined UICC stages 2, 3 and 4 (advanced stages) were reported for a two-year period. Proportions were tested for significance by using chi-square tests (p < 0.001).


RESULTS
The 2-year incidence rate of all stages was significantly lower in participants in subsequent screening than in initial screening (0.85 vs. 1.29 per 100 women (%); p < 0.0001). A significantly lower 2-year incidence of advanced stages was observed for subsequent screening compared to initial screening (0.26 % vs. 0.48 %; p = 0.0007). Among women aged 50 to 59 years, the incidence of advanced stages was less clearly different (0.21 % vs. 0.35 %; p = 0.07) than in women aged 60 to 69 years (0.31 % vs. 0.70 %; p = 0.0008).


CONCLUSIONS
During the change from prevalent to incident phase mammography screening, a program impact is seen by a lower 2-year incidence of advanced breast cancers within subsequent compared to initial participants, predominately in women aged 60 to 69 years.


CONCLUSIONS
• The incidence of advanced tumor stages represents the most relevant surrogate parameter for screening effectiveness. • For the first time the 2-year incidence of advanced breast cancer stages after subsequent mammography screening was analyzed. • We observed a significant effect of screening on the 2-year incidence of advanced stages, predominately in the age group 60 to 69 years.
Department of Clinical Radiology, University Hospital Muenster, Germany.
S
S
Weigel
Department of Clinical Radiology, University Hospital Muenster, Germany.
W
W
Heindel
Epidemiological Cancer Registry of North Rhine-Westphalia, Muenster, Germany.
J
J
Heidrich
Epidemiological Cancer Registry of North Rhine-Westphalia, Muenster, Germany.
O
O
Heidinger
Institute of Epidemiology and Social Medicine, University of Muenster, Germany.
H W
HW
Hense
D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D006801:Humans; D015994:Incidence; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011856:Radiographic Image Enhancement; D014600:Utilization Review / Q000706:statistics & numerical data