The effect of the Flemish breast cancer screening program on breast cancer-specific mortality: A case-referent study |
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| Affiliation: | 1. KU Leuven, Department of Oncology, Leuven, Belgium;2. Belgian Cancer Registry, Research Department, Brussels, Belgium;3. Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Oncologisch Centrum - Department of Medical Oncology, Brussels, Belgium;4. General Hospital Groeninge, Kortrijk Cancer Centre, Kortrijk, Belgium;5. Anglia Ruskin University, Medical Technology Research Centre (MTRC), School of Life Sciences, Cambridge, UK;6. University of Plymouth, School of Nursing & Midwifery, Plymouth, UK;7. Iridium Cancer Network Antwerp - Sint-Augustinus, Department of Geriatric Medicine, Wilrijk, Belgium;8. ULB Institute Jules Bordet, Department of Hematology, Brussels, Belgium;9. Cliniques Universitaires Saint-Luc - UCLouvain, Department of Medical Oncology, Brussels, Belgium;10. University Hospital Erasme- Université Libre de Bruxelles ULB, Department Medical Oncology, Brussels, Belgium;11. Clinique CHC-MontLégia, Groupe Santé CHC-Liège, Department of Oncology, Liège, Belgium;12. GHDC Grand Hôpital de Charleroi, Department of Medical Oncology, Charleroi, Belgium;13. Centre Hospitalier de Mouscron, Department of Geriatric Medicine, Mouscron, Belgium;14. AZ Klina, Department of Medical Oncology, Brasschaat, Belgium;15. Imelda Hospital, Department of Medical Oncology, Bonheiden, Belgium;p. CHU-UCL-Namur, Department of Medical Oncology, Namur, Belgium;q. ZNA Stuivenberg, Department Medical Oncology, Antwerp, Belgium;r. Centre Hospitalier Universitaire Sart Tilman - Liège University, Department of Medical Oncology, Liège, Belgium;s. ZNA Middelheim, Department of Medical Oncology, Antwerp, Belgium;t. Centre Hospitalier Jolimont, Department of Medical Oncology, La Louvière, Belgium;u. University Hospital Antwerp, Department of Medical Oncology, Edegem, Belgium;v. CHU St-Pierre - Free Universities Brussels, Department of Geriatric Medicine, Brussels, Belgium;w. AZ Vesalius, Department of Medical Oncology, Tongeren, Belgium;x. University Hospitals Leuven – KU Leuven, Department of Geriatric Medicine – Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium;y. University Hospitals Leuven – KU Leuven, Department of Geriatric Medicine – Department of Public Health and Primary Care, Gerontology and Geriatrics, Leuven, Belgium;z. University Hospitals Leuven, Department of General Medical Oncology – Department of Geriatric Medicine, Leuven, Belgium;11. University Hospitals Leuven - KU Leuven, Department of General Medical Oncology - Department of Oncology, Leuven, Belgium |
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| Abstract: | BackgroundBreast cancer screening programs were introduced in many countries worldwide following randomized controlled trials in the 1980s showing a reduction in breast cancer-specific mortality. However, their effectiveness remains debated and estimates vary. A breast cancer screening program was introduced in 2001 in Flanders, Belgium where high levels of opportunistic screening practices are observed. The effectiveness of this program was estimated by measuring its effect on breast cancer-specific mortality.MethodsWe performed a case-referent study to investigate the effect of participation in the Flemish population-based mammography screening program (PMSP) on breast cancer-specific mortality from 2005 to 2017. A multiple logistic regression model assessed the association between breast cancer-specific death and screening program participation status in the four years prior to (pseudo)diagnosis (yes/no), with adjustment for potential confounders (individual socio-economic position and calendar year of diagnosis) and stratified for age. In addition, we performed different sensitivity analyses.ResultsWe identified 1571 cases and randomly selected 6284 referents. After adjustment, women who participated in PMSP had a 51 % lower risk of breast cancer-specific mortality compared to those who did not (adjusted odds ratio [aOR] =0.49, 95 % CI: 0.44–0.55). Sensitivity analyses did not markedly change the estimated associations. Correction for self-selection bias reduced the effect size, but the estimate remained significant.ConclusionOur results indicate that in a context of high opportunistic screening rates, participation in breast cancer screening program substantially reduces breast cancer-specific mortality. For policy, these results should be balanced against the potential harms of screening, including overdiagnosis and overtreatment. |
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| Keywords: | Breast cancer Mass screening Mortality Case-control studies Belgium |
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