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+.
| Original language | English |
|---|---|
| Pages (from-to) | 109-116 |
| Number of pages | 8 |
| Journal | European Journal of Cancer |
| Volume | 75 |
| DOIs | |
| Publication status | Published - Apr 1 2017 |
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Keywords
- Advanced breast cancer
- Cohort study
- Mammography screening
- Screening attendance
- Screening effectiveness
- Self-selection bias
ASJC Scopus subject areas
- Oncology
- Cancer Research
Cite this
Advanced breast cancer rates in the epoch of service screening : The 400,000 women cohort study from Italy. / Puliti, Donella; Bucchi, Lauro; Mancini, Silvia; Paci, Eugenio; Baracco, Susanna; Campari, Cinzia; Canuti, Debora; Cirilli, Claudia; Collina, Natalina; Conti, Giovanni Maria; Di Felice, Enza; Falcini, Fabio; Michiara, Maria; Negri, Rossella; Ravaioli, Alessandra; Sassoli de' Bianchi, Priscilla; Serafini, Monica; Zorzi, Manuel; Caldarella, Adele; Cataliotti, Luigi; Zappa, Marco; Manneschi, G.; Miccinesi, Guido; Caranci, Nicola; Naldoni, Carlo; Finarelli, A. C.; Ferretti, S.; Pandolfi, P.; Pizzi, G. L.; Petrucci, C.; Baldazzi, P.; Pasquini, A.; Manfredi, M.; Saguatti, G.; Zatelli, Marella; Sgargi, P.; Bozzani, F.; Giorgi Rossi, P.; Mangone, L.; Caroli, S.; Vicentini, M. T.; Vattiato, Rosa; Giuliani, O.; Balducci, C.; Vitali, B.; Monticelli, G.
In: European Journal of Cancer, Vol. 75, 01.04.2017, p. 109-116.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Advanced breast cancer rates in the epoch of service screening
T2 - The 400,000 women cohort study from Italy
AU - Puliti, Donella
AU - Bucchi, Lauro
AU - Mancini, Silvia
AU - Paci, Eugenio
AU - Baracco, Susanna
AU - Campari, Cinzia
AU - Canuti, Debora
AU - Cirilli, Claudia
AU - Collina, Natalina
AU - Conti, Giovanni Maria
AU - Di Felice, Enza
AU - Falcini, Fabio
AU - Michiara, Maria
AU - Negri, Rossella
AU - Ravaioli, Alessandra
AU - Sassoli de' Bianchi, Priscilla
AU - Serafini, Monica
AU - Zorzi, Manuel
AU - Caldarella, Adele
AU - Cataliotti, Luigi
AU - Zappa, Marco
AU - Manneschi, G.
AU - Miccinesi, Guido
AU - Caranci, Nicola
AU - Naldoni, Carlo
AU - Finarelli, A. C.
AU - Ferretti, S.
AU - Pandolfi, P.
AU - Pizzi, G. L.
AU - Petrucci, C.
AU - Baldazzi, P.
AU - Pasquini, A.
AU - Manfredi, M.
AU - Saguatti, G.
AU - Zatelli, Marella
AU - Sgargi, P.
AU - Bozzani, F.
AU - Giorgi Rossi, P.
AU - Mangone, L.
AU - Caroli, S.
AU - Vicentini, M. T.
AU - Vattiato, Rosa
AU - Giuliani, O.
AU - Balducci, C.
AU - Vitali, B.
AU - Monticelli, G.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - 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+.
AB - 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+.
KW - Advanced breast cancer
KW - Cohort study
KW - Mammography screening
KW - Screening attendance
KW - Screening effectiveness
KW - Self-selection bias
UR - http://www.scopus.com/inward/record.url?scp=85013057066&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85013057066&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2016.12.030
DO - 10.1016/j.ejca.2016.12.030
M3 - Article
AN - SCOPUS:85013057066
VL - 75
SP - 109
EP - 116
JO - European Journal of Cancer
JF - European Journal of Cancer
SN - 0959-8049
ER -