A case–control study to evaluate the impact of the breast screening programme on breast cancer incidence in England

TY - JOUR

T1 - A case–control study to evaluate the impact of the breast screening programme on breast cancer incidence in England

AU - Blyuss, Oleg

AU - Dibden, Amanda

AU - Massat, Nathalie J.

AU - Parmar, Dharmishta

AU - Cuzick, Jack

AU - Duffy, Stephen W.

AU - Sasieni, Peter

N1 - Funding Information: This research was funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Cancer Awareness, Screening, and Early Diagnosis, PR‐PRU‐1217‐21601. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: © 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

PY - 2022/7/18

Y1 - 2022/7/18

N2 - Background: There is uncertainty about overdiagnosis in mammography screening. Methods: We aimed to estimate the effect of screening on breast cancer incidence and overdiagnosis in the NHS Breast Screening Programme in England. The study included 57,493 cases and 105,653 controls, with cases defined as women diagnosed at ages 47–89 with primary breast cancer, invasive or ductal carcinoma in situ, in 2010 or 2011. Where possible, two controls were selected per case, matched on date of birth and screening area. Conditional logistic regression was used to estimate the effect of screening on breast cancer risk, with adjustment for potential self-selection bias. Results were combined with national incidence data to estimate absolute rates of overdiagnosis. Overdiagnosis was calculated as the cumulative excess of cancers diagnosed in the age group 50–77 in a woman attending three-yearly screening between ages 50 and 70 compared with a woman attending no screens. Results: The estimated number of cases overdiagnosed in women attending all screens in the programme was 679.3 per 100,000 without adjustment for self-selection bias and 261.2 per 100,000 with adjustment. These corresponded to an estimated 9.5% of screen-detected cancers overdiagnosed without adjustment and 3.7% with adjustment for self-selection. Conclusions: The NHS Breast Screening Programme in England confers at worst modest levels of overdiagnosis.

AB - Background: There is uncertainty about overdiagnosis in mammography screening. Methods: We aimed to estimate the effect of screening on breast cancer incidence and overdiagnosis in the NHS Breast Screening Programme in England. The study included 57,493 cases and 105,653 controls, with cases defined as women diagnosed at ages 47–89 with primary breast cancer, invasive or ductal carcinoma in situ, in 2010 or 2011. Where possible, two controls were selected per case, matched on date of birth and screening area. Conditional logistic regression was used to estimate the effect of screening on breast cancer risk, with adjustment for potential self-selection bias. Results were combined with national incidence data to estimate absolute rates of overdiagnosis. Overdiagnosis was calculated as the cumulative excess of cancers diagnosed in the age group 50–77 in a woman attending three-yearly screening between ages 50 and 70 compared with a woman attending no screens. Results: The estimated number of cases overdiagnosed in women attending all screens in the programme was 679.3 per 100,000 without adjustment for self-selection bias and 261.2 per 100,000 with adjustment. These corresponded to an estimated 9.5% of screen-detected cancers overdiagnosed without adjustment and 3.7% with adjustment for self-selection. Conclusions: The NHS Breast Screening Programme in England confers at worst modest levels of overdiagnosis.

KW - breast cancer

KW - cancer prevention

KW - screening

KW - women's cancer

UR - http://www.scopus.com/inward/record.url?scp=85135046563&partnerID=8YFLogxK

U2 - 10.1002/cam4.5004

DO - 10.1002/cam4.5004

M3 - Article

AN - SCOPUS:85135046563

SN - 2045-7634

JO - Cancer Medicine

JF - Cancer Medicine

ER -