Advanced breast cancer rates in the epoch of service screening: The 400,000 women cohort study from Italy

Donella Puliti, Lauro Bucchi, Silvia Mancini, Eugenio Paci, Susanna Baracco, Cinzia Campari, Debora Canuti, Claudia Cirilli, Natalina Collina, Giovanni Maria Conti, Enza Di Felice, Fabio Falcini, Maria Michiara, Rossella Negri, Alessandra Ravaioli, Priscilla Sassoli de' Bianchi, Monica Serafini, Manuel Zorzi, Adele Caldarella, Luigi CataliottiMarco Zappa, G. Manneschi, Guido Miccinesi, Nicola Caranci, Carlo Naldoni, A. C. Finarelli, S. Ferretti, P. Pandolfi, G. L. Pizzi, C. Petrucci, P. Baldazzi, A. Pasquini, M. Manfredi, G. Saguatti, Marella Zatelli, P. Sgargi, F. Bozzani, P. Giorgi Rossi, L. Mangone, S. Caroli, M. T. Vicentini, Rosa Vattiato, O. Giuliani, C. Balducci, B. Vitali, G. Monticelli

Research output: Contribution to journalArticle

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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 languageEnglish
Pages (from-to)109-116
Number of pages8
JournalEuropean Journal of Cancer
Volume75
DOIs
Publication statusPublished - Apr 1 2017

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Italy
Cohort Studies
Confidence Intervals
Breast Neoplasms
Incidence
Selection Bias
Neoplasms
Mammography
Economics
insulin receptor-related receptor

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 journalArticle

Puliti, D, Bucchi, L, Mancini, S, Paci, E, Baracco, S, Campari, C, Canuti, D, Cirilli, C, Collina, N, Conti, GM, Di Felice, E, Falcini, F, Michiara, M, Negri, R, Ravaioli, A, Sassoli de' Bianchi, P, Serafini, M, Zorzi, M, Caldarella, A, Cataliotti, L, Zappa, M, Manneschi, G, Miccinesi, G, Caranci, N, Naldoni, C, Finarelli, AC, Ferretti, S, Pandolfi, P, Pizzi, GL, Petrucci, C, Baldazzi, P, Pasquini, A, Manfredi, M, Saguatti, G, Zatelli, M, Sgargi, P, Bozzani, F, Giorgi Rossi, P, Mangone, L, Caroli, S, Vicentini, MT, Vattiato, R, Giuliani, O, Balducci, C, Vitali, B & Monticelli, G 2017, 'Advanced breast cancer rates in the epoch of service screening: The 400,000 women cohort study from Italy', European Journal of Cancer, vol. 75, pp. 109-116. https://doi.org/10.1016/j.ejca.2016.12.030
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. / Advanced breast cancer rates in the epoch of service screening : The 400,000 women cohort study from Italy. In: European Journal of Cancer. 2017 ; Vol. 75. pp. 109-116.
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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+.",
keywords = "Advanced breast cancer, Cohort study, Mammography screening, Screening attendance, Screening effectiveness, Self-selection bias",
author = "Donella Puliti and Lauro Bucchi and Silvia Mancini and Eugenio Paci and Susanna Baracco and Cinzia Campari and Debora Canuti and Claudia Cirilli and Natalina Collina and Conti, {Giovanni Maria} and {Di Felice}, Enza and Fabio Falcini and Maria Michiara and Rossella Negri and Alessandra Ravaioli and {Sassoli de' Bianchi}, Priscilla and Monica Serafini and Manuel Zorzi and Adele Caldarella and Luigi Cataliotti and Marco Zappa and G. Manneschi and Guido Miccinesi and Nicola Caranci and Carlo Naldoni and Finarelli, {A. C.} and S. Ferretti and P. Pandolfi and Pizzi, {G. L.} and C. Petrucci and P. Baldazzi and A. Pasquini and M. Manfredi and G. Saguatti and Marella Zatelli and P. Sgargi and F. Bozzani and {Giorgi Rossi}, P. and L. Mangone and S. Caroli and Vicentini, {M. T.} and Rosa Vattiato and O. Giuliani and C. Balducci and B. Vitali and G. Monticelli",
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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

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DO - 10.1016/j.ejca.2016.12.030

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JO - European Journal of Cancer

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