Impact of mammographic screening and advanced cancer definition on the percentage of advanced-stage cancers in a steady-state breast screening programme in the Netherlands.

Autor: de Munck L; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands. l.demunck@iknl.nl.; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. l.demunck@iknl.nl., Siesling S; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.; Department of Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands., Fracheboud J; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands., den Heeten GJ; Dutch Expert Centre for Screening, Nijmegen, The Netherlands.; Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Broeders MJM; Dutch Expert Centre for Screening, Nijmegen, The Netherlands.; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands., de Bock GH; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Jazyk: angličtina
Zdroj: British journal of cancer [Br J Cancer] 2020 Sep; Vol. 123 (7), pp. 1191-1197. Date of Electronic Publication: 2020 Jul 09.
DOI: 10.1038/s41416-020-0968-6
Abstrakt: Background: To estimate the percentages of advanced-stage breast cancers (BCs) detected during the course of a steady-state screening programme when using different definitions of advanced BC.
Methods: Data of women aged 49-74 years, diagnosed with BC in 2006-2015, were selected from the Netherlands Cancer Registry and linked to the screening registry. BCs were classified as screen-detected, interval or non-screened. Three definitions of advanced BC were used for comparison: TNM stage (III-IV), NM stage (N+ and/or M+) and T size (invasive tumour ≥15 mm). Analyses were performed assuming a 10% overdiagnosis rate. In sensitivity analyses, this assumption varied from 0 to 30%.
Results: We included 46,734 screen-detected, 17,362 interval and 24,189 non-screened BCs. By TNM stage, 4.9% of screen-detected BCs were advanced, compared with 19.4% and 22.8% of interval and non-screened BCs, respectively (p < 0.001). Applying the other definitions led to higher percentages of advanced BC being detected. Depending on the definition interval, non-screened BCs had a 2-5-times risk of being advanced.
Conclusion: Irrespective of the definition, screen-detected BCs were less frequently in the advanced stage. These findings provide evidence of a stage shift to early detection and support the potential of mammographic screening to reduce treatment-related burdens and the mortality associated with BC.
Databáze: MEDLINE
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