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The effect of the Flemish breast cancer screening program on breast cancer-specific mortality: A case-referent study
Breast 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...
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| Published in: | Cancer epidemiology 2023-02, Vol.82, p.102320-102320, Article 102320 |
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| container_end_page | 102320 |
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| container_title | Cancer epidemiology |
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| creator | De Troeyer, Katrien Silversmit, Geert Rosskamp, Michael Truyen, Inge Van Herck, Koen Goossens, Mathijs Michiel Martens, Patrick Kellen, Eliane Hendrickx, Erik Rummens, Elise De Smet, Frank Broeders, Mireille Verdoodt, Freija De Schutter, Harlinde |
| description | Breast 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.
We 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.
We 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.
Our 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.
•Evaluation screening program in Flanders with high opportunistic mammography rate.•Mammography screening program substantially reduces breast cancer death in Flanders.•Results were robust over provinces and to correction for additional confounders.•Reduced effect size remained significant after correction for self-selection bias. |
| doi_str_mv | 10.1016/j.canep.2022.102320 |
| format | article |
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We 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.
We 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.
Our 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.
•Evaluation screening program in Flanders with high opportunistic mammography rate.•Mammography screening program substantially reduces breast cancer death in Flanders.•Results were robust over provinces and to correction for additional confounders.•Reduced effect size remained significant after correction for self-selection bias.</description><identifier>ISSN: 1877-7821</identifier><identifier>EISSN: 1877-783X</identifier><identifier>DOI: 10.1016/j.canep.2022.102320</identifier><identifier>PMID: 36608495</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Belgium ; Bias ; Breast cancer ; Breast Neoplasms - diagnosis ; Cancer ; Cancer screening ; Case-Control Studies ; Diagnosis ; Early Detection of Cancer - methods ; Effectiveness ; Epidemiology ; Estimates ; Female ; Health insurance ; Health risks ; Humans ; Logistic Models ; Mammography ; Mammography - methods ; Mass screening ; Mass Screening - methods ; Medical screening ; Mortality ; Observational studies ; Participation ; Performance evaluation ; Population-based studies ; Reimbursement ; Sensitivity analysis ; Womens health</subject><ispartof>Cancer epidemiology, 2023-02, Vol.82, p.102320-102320, Article 102320</ispartof><rights>2023 Elsevier Ltd</rights><rights>Copyright © 2023 Elsevier Ltd. All rights reserved.</rights><rights>2023. Elsevier Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c387t-46fdf4e362a6ca9f9bda1c1f194b5d2e154bf675ae85f4d1df6b3f788bb040a23</citedby><cites>FETCH-LOGICAL-c387t-46fdf4e362a6ca9f9bda1c1f194b5d2e154bf675ae85f4d1df6b3f788bb040a23</cites><orcidid>0000-0001-8067-6390 ; 0000-0002-2013-2065 ; 0000-0001-9327-8981 ; 0000-0003-0717-2406 ; 0000-0003-1104-1839 ; 0000-0002-8741-8148</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36608495$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>De Troeyer, Katrien</creatorcontrib><creatorcontrib>Silversmit, Geert</creatorcontrib><creatorcontrib>Rosskamp, Michael</creatorcontrib><creatorcontrib>Truyen, Inge</creatorcontrib><creatorcontrib>Van Herck, Koen</creatorcontrib><creatorcontrib>Goossens, Mathijs Michiel</creatorcontrib><creatorcontrib>Martens, Patrick</creatorcontrib><creatorcontrib>Kellen, Eliane</creatorcontrib><creatorcontrib>Hendrickx, Erik</creatorcontrib><creatorcontrib>Rummens, Elise</creatorcontrib><creatorcontrib>De Smet, Frank</creatorcontrib><creatorcontrib>Broeders, Mireille</creatorcontrib><creatorcontrib>Verdoodt, Freija</creatorcontrib><creatorcontrib>De Schutter, Harlinde</creatorcontrib><title>The effect of the Flemish breast cancer screening program on breast cancer-specific mortality: A case-referent study</title><title>Cancer epidemiology</title><addtitle>Cancer Epidemiol</addtitle><description>Breast 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.
We 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.
We 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.
Our 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.
•Evaluation screening program in Flanders with high opportunistic mammography rate.•Mammography screening program substantially reduces breast cancer death in Flanders.•Results were robust over provinces and to correction for additional confounders.•Reduced effect size remained significant after correction for self-selection bias.</description><subject>Belgium</subject><subject>Bias</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - diagnosis</subject><subject>Cancer</subject><subject>Cancer screening</subject><subject>Case-Control Studies</subject><subject>Diagnosis</subject><subject>Early Detection of Cancer - methods</subject><subject>Effectiveness</subject><subject>Epidemiology</subject><subject>Estimates</subject><subject>Female</subject><subject>Health insurance</subject><subject>Health risks</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Mammography</subject><subject>Mammography - methods</subject><subject>Mass screening</subject><subject>Mass Screening - methods</subject><subject>Medical screening</subject><subject>Mortality</subject><subject>Observational studies</subject><subject>Participation</subject><subject>Performance evaluation</subject><subject>Population-based studies</subject><subject>Reimbursement</subject><subject>Sensitivity analysis</subject><subject>Womens health</subject><issn>1877-7821</issn><issn>1877-783X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kctKxDAUhoMo3p9AkIAbNx2TtE1awcUg3mDAzQjuQpqcaIZexiQV5u3NOCrowlWSk-_c_h-hE0omlFB-sZho1cNywghjKcJyRrbQPq2EyESVP2__3BndQwchLAjhnNJyF-3lnJOqqMt9FOevgMFa0BEPFsf0um2hc-EVNx5UiDg10eBx0B6gd_0LXvrhxasOD_1vJAtL0M46jbvBR9W6uLrE0_QZIPNgwUMfcYijWR2hHavaAMdf5yF6ur2ZX99ns8e7h-vpLNN5JWJWcGtsATlnimtV27oximpqaV00pWFAy6KxXJQKqtIWhhrLm9yKqmoaUhDF8kN0vqmbRn4bIUSZFtPQtkm3YQySCU5rUTKxRs_-oIth9H2abk2VgjFOSaLyDaX9EEJaSi6965RfSUrk2hS5kJ-myLUpcmNKyjr9qj02HZifnG8XEnC1ASCJ8e7Ay6AdJE2N88kYaQb3b4MPnYifYQ</recordid><startdate>202302</startdate><enddate>202302</enddate><creator>De Troeyer, Katrien</creator><creator>Silversmit, Geert</creator><creator>Rosskamp, Michael</creator><creator>Truyen, Inge</creator><creator>Van Herck, Koen</creator><creator>Goossens, Mathijs Michiel</creator><creator>Martens, Patrick</creator><creator>Kellen, Eliane</creator><creator>Hendrickx, Erik</creator><creator>Rummens, Elise</creator><creator>De Smet, Frank</creator><creator>Broeders, Mireille</creator><creator>Verdoodt, Freija</creator><creator>De Schutter, Harlinde</creator><general>Elsevier Ltd</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8067-6390</orcidid><orcidid>https://orcid.org/0000-0002-2013-2065</orcidid><orcidid>https://orcid.org/0000-0001-9327-8981</orcidid><orcidid>https://orcid.org/0000-0003-0717-2406</orcidid><orcidid>https://orcid.org/0000-0003-1104-1839</orcidid><orcidid>https://orcid.org/0000-0002-8741-8148</orcidid></search><sort><creationdate>202302</creationdate><title>The effect of the Flemish breast cancer screening program on breast cancer-specific mortality: A case-referent study</title><author>De Troeyer, Katrien ; Silversmit, Geert ; Rosskamp, Michael ; Truyen, Inge ; Van Herck, Koen ; Goossens, Mathijs Michiel ; Martens, Patrick ; Kellen, Eliane ; Hendrickx, Erik ; Rummens, Elise ; De Smet, Frank ; Broeders, Mireille ; Verdoodt, Freija ; De Schutter, Harlinde</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c387t-46fdf4e362a6ca9f9bda1c1f194b5d2e154bf675ae85f4d1df6b3f788bb040a23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Belgium</topic><topic>Bias</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - 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Academic</collection><jtitle>Cancer epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>De Troeyer, Katrien</au><au>Silversmit, Geert</au><au>Rosskamp, Michael</au><au>Truyen, Inge</au><au>Van Herck, Koen</au><au>Goossens, Mathijs Michiel</au><au>Martens, Patrick</au><au>Kellen, Eliane</au><au>Hendrickx, Erik</au><au>Rummens, Elise</au><au>De Smet, Frank</au><au>Broeders, Mireille</au><au>Verdoodt, Freija</au><au>De Schutter, Harlinde</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effect of the Flemish breast cancer screening program on breast cancer-specific mortality: A case-referent study</atitle><jtitle>Cancer epidemiology</jtitle><addtitle>Cancer Epidemiol</addtitle><date>2023-02</date><risdate>2023</risdate><volume>82</volume><spage>102320</spage><epage>102320</epage><pages>102320-102320</pages><artnum>102320</artnum><issn>1877-7821</issn><eissn>1877-783X</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Breast 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.
We 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.
We 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.
Our 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.
•Evaluation screening program in Flanders with high opportunistic mammography rate.•Mammography screening program substantially reduces breast cancer death in Flanders.•Results were robust over provinces and to correction for additional confounders.•Reduced effect size remained significant after correction for self-selection bias.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>36608495</pmid><doi>10.1016/j.canep.2022.102320</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0001-8067-6390</orcidid><orcidid>https://orcid.org/0000-0002-2013-2065</orcidid><orcidid>https://orcid.org/0000-0001-9327-8981</orcidid><orcidid>https://orcid.org/0000-0003-0717-2406</orcidid><orcidid>https://orcid.org/0000-0003-1104-1839</orcidid><orcidid>https://orcid.org/0000-0002-8741-8148</orcidid></addata></record> |
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| identifier | ISSN: 1877-7821 |
| ispartof | Cancer epidemiology, 2023-02, Vol.82, p.102320-102320, Article 102320 |
| issn | 1877-7821 1877-783X |
| language | eng |
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| source | ScienceDirect Freedom Collection |
| subjects | Belgium Bias Breast cancer Breast Neoplasms - diagnosis Cancer Cancer screening Case-Control Studies Diagnosis Early Detection of Cancer - methods Effectiveness Epidemiology Estimates Female Health insurance Health risks Humans Logistic Models Mammography Mammography - methods Mass screening Mass Screening - methods Medical screening Mortality Observational studies Participation Performance evaluation Population-based studies Reimbursement Sensitivity analysis Womens health |
| title | The effect of the Flemish breast cancer screening program on breast cancer-specific mortality: A case-referent study |
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