title: Breast cancer screening-opportunistic use of registry and linked screening data for local evaluation.
abstract: BACKGROUND
  Screening has been found to reduce breast cancer mortality at a population level in Australia, but these studies did not address local settings where numbers of deaths would generally have been too low for evaluation. Clinicians, administrators, and consumer groups are also interested in local service outcomes. We therefore use more common prognostic and treatment measures and survivals to gain evidence of screening effects among patients attending 4 local hospitals for treatment.
  
  
  OBJECTIVE
  To compare prognostic, treatment, and survival measures by screening history to determine whether expected screening effects are occurring.
  
  
  METHODS
  Employing routine clinical registry and linked screening data to investigate associations of screening history with these measures, using unadjusted and adjusted analyses.
  
  
  RESULTS
  Screened women had a 10-year survival from breast cancer of 92%, compared with 78% for unscreened women; and 79% of screened surgical cases had breast conserving surgery compared with 64% in unscreened women. Unadjusted analyses indicated that recently screened cases had earlier tumor node metastasis stages, smaller diameters, less nodal involvement, better tumor differentiation, more oestrogen and progesterone receptor positive lesions, more hormone therapy, and less chemotherapy. Radiotherapy tended to be more common in screening participants. More frequent use of adjunctive radiotherapy applied when breast conserving surgery was used.
  
  
  CONCLUSIONS
  Results confirm the screening effects expected from the scientific literature and demonstrate the value of opportunistic use of available registry and linked screening data for indicating to local health administrations, practitioners, and consumers whether local screening services are having the effects expected.
authors.affiliation: Cancer Epidemiology and Population Health, University of South Australia, Adelaide, SA, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Roder
authors.affiliation: SA Health, BreastScreen SA, Adelaide, SA, Australia.
authors.forename: Gelareh
authors.initials: G
authors.lastname: Farshid
authors.affiliation: Breast Endocrine and Surgical Oncology Unit, RAH, Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Grantley
authors.initials: G
authors.lastname: Gill
authors.affiliation: SA Health, Adelaide, SA, Australia.
authors.forename: Jim
authors.initials: J
authors.lastname: Kollias
authors.affiliation: Department of Medical Oncology, Flinders University, Adelaide, SA, Australia.
authors.forename: Bogda
authors.initials: B
authors.lastname: Koczwara
authors.affiliation: Department of Medical Oncology, Flinders University, Bedford Park, SA, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Karapetis
authors.affiliation: Medical Oncology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.
authors.forename: Jacqui
authors.initials: J
authors.lastname: Adams
authors.affiliation: Medical Oncology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.
authors.forename: Rohit
authors.initials: R
authors.lastname: Joshi
authors.affiliation: SA Health, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Keefe
authors.affiliation: Population Health, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, SA, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Powell
authors.affiliation: Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia.
authors.forename: Kellie
authors.initials: K
authors.lastname: Fusco
authors.affiliation: Cancer Nursing, University of South Australia, Adelaide, SA, Australia.
authors.forename: Marion
authors.initials: M
authors.lastname: Eckert
authors.affiliation: Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia.
authors.forename: Elizabeth
authors.identifier: http://orcid.org/0000-0001-8980-1194
authors.initials: E
authors.lastname: Buckley
authors.affiliation: Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia.
authors.forename: Kerri
authors.initials: K
authors.lastname: Beckmann
mesh_terms: D000367:Age Factors; D000368:Aged; D001315:Australia; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data; D013997:Time Factors
keywords: evaluation; health care; public health