Donella Puliti1, Lauro Bucchi2, Silvia Mancini2, Eugenio Paci1, Susanna Baracco3, Cinzia Campari4, Debora Canuti5, Claudia Cirilli6, Natalina Collina7, Giovanni Maria Conti8, Enza Di Felice4, Fabio Falcini5, Maria Michiara9, Rossella Negri10, Alessandra Ravaioli2, Priscilla Sassoli De' Bianchi11, Monica Serafini5, Manuel Zorzi3, Adele Caldarella1, Luigi Cataliotti12, Marco Zappa13. 1. ISPO - Cancer Research and Prevention Institute, Clinical Epidemiology, Florence 50141, Italy. 2. Romagna Cancer Registry, Romagna Cancer Institute (IRST) IRCCS, Meldola, Forlì 47014, Italy. 3. Veneto Cancer Registry, Veneto Region, Padua 35131, Italy. 4. Planning and Control Staff, Local Health Unit, Reggio Emilia 42122, Italy; Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia 42122, Italy. 5. Screening Center - Romagna Local Health Unit, Ravenna 48121, Italy. 6. Unit of Epidemiology and Risk Communication, Local Health Unit, Modena 41126, Italy. 7. Unit of Epidemiology, Health Promotion and Risk Communication, Department of Public Health, Bologna Local Health Authority, Bologna 40121, Italy. 8. Mammography Screening Programme, Local Health Unit, Parma 43100, Italy. 9. Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, 43100 Parma, Italy. 10. Mammography Screening Center, Local Health Unit, Modena 41124, Italy. 11. Regional Health Department, Public Health Service, Emilia-Romagna Region, Bologna 40127, Italy. 12. Breast Centres Certification and Senonetwork Italia Onlus, Florence 50129, Italy. 13. ISPO - Cancer Research and Prevention Institute, Clinical Epidemiology, Florence 50141, Italy. Electronic address: m.zappa@ispo.toscana.it.
Abstract
BACKGROUND: The objective of this study was to evaluate if mammography screening attendance is associated with a reduction in late-stage breast cancer incidence. METHODS: The cohort included over 400,000 Italian women who were first invited to participate in regional screening programmes during the 1990s and were followed for breast cancer incidence for 13 years. We obtained individual data on their exposure to screening and correlated this with total and stage-specific breast cancer incidence. Socio-economic status and pre-screening incidence data were used to assess the presence of self-selection bias. RESULTS: Overall, screening attendance was associated with a 10% excess risk of in situ and invasive breast cancer (IRR = 1.10; 95% confidence interval (CI): 1.06-1.14), which dropped to 5% for invasive cancers only (IRR = 1.05; 95% CI: 1.01-1.09). There were significant reductions among attenders for specific cancer stages; we observed a 39% reduction for T2 or larger (IRR = 0.61; 95% CI: 0.57-0.66), 19% for node positives (IRR = 0.81; 95% CI: 0.76-0.86) and 28% for stage II and higher (IRR = 0.72; 95% CI: 0.68-0.76). Our data suggest that the presence of self-selection bias is limited and, overall, invited women experienced a 17% reduction of advanced cancers compared with pre-screening rates. CONCLUSIONS: Comparing attenders' and non-attenders' stage-specific breast cancer incidence, we have estimated that screening attendance is associated with a reduction of nearly 30% for stages II+.
BACKGROUND: The objective of this study was to evaluate if mammography screening attendance is associated with a reduction in late-stage breast cancer incidence. METHODS: The cohort included over 400,000 Italian women who were first invited to participate in regional screening programmes during the 1990s and were followed for breast cancer incidence for 13 years. We obtained individual data on their exposure to screening and correlated this with total and stage-specific breast cancer incidence. Socio-economic status and pre-screening incidence data were used to assess the presence of self-selection bias. RESULTS: Overall, screening attendance was associated with a 10% excess risk of in situ and invasive breast cancer (IRR = 1.10; 95% confidence interval (CI): 1.06-1.14), which dropped to 5% for invasive cancers only (IRR = 1.05; 95% CI: 1.01-1.09). There were significant reductions among attenders for specific cancer stages; we observed a 39% reduction for T2 or larger (IRR = 0.61; 95% CI: 0.57-0.66), 19% for node positives (IRR = 0.81; 95% CI: 0.76-0.86) and 28% for stage II and higher (IRR = 0.72; 95% CI: 0.68-0.76). Our data suggest that the presence of self-selection bias is limited and, overall, invited women experienced a 17% reduction of advanced cancers compared with pre-screening rates. CONCLUSIONS: Comparing attenders' and non-attenders' stage-specific breast cancer incidence, we have estimated that screening attendance is associated with a reduction of nearly 30% for stages II+.
Authors: M J M Broeders; P Allgood; S W Duffy; S Hofvind; I D Nagtegaal; E Paci; S M Moss; L Bucchi Journal: BMC Cancer Date: 2018-09-03 Impact factor: 4.430
Authors: Olle Melander; Paola Antonini; Filip Ottosson; Louise Brunkwall; Widet Gallo; Peter M Nilsson; Marju Orho-Melander; Gaetano Pacente; Giovanni D'Arena; Salvatore Di Somma Journal: Intern Emerg Med Date: 2021-01-30 Impact factor: 3.397