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, IMPACT COHORT Working Group

Research output: Contribution to journalArticlepeer-review


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
Publication statusPublished - Apr 2017


  • Aged
  • Breast Neoplasms
  • Cohort Studies
  • Early Detection of Cancer
  • Female
  • Humans
  • Incidence
  • Italy
  • Mammography
  • Mass Screening
  • Middle Aged
  • No-Show Patients
  • Patient Acceptance of Health Care
  • Socioeconomic Factors
  • Evaluation Studies
  • Journal Article


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