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Title: Treatment Intensity Differences After Early-Stage Breast Cancer (ESBC) Diagnosis Depending on Participation in a Screening Program
Authors: Elder K; Nickson C; Pattanasri M; Cooke S; Machalek D; Rose A; Mou A; Collins JP; Park A; De Boer R; Phillips C; Pridmore V; Farrugia H; Mann GB
Categories: Cancer Type - Breast Cancer
Treatment - Resources and Infrastructure
Year: 2018
Journal Title: Annals of Surgical Oncology
Volume: 25
Issue: 9
Page number start: 2563
Page number end: 2572
Abstract: Background While population mammographic screening identifies early-stage breast cancers (ESBCs; ductal carcinoma in situ [DCIS] and invasive disease stages 1–3A), commentaries suggest that harms from overdiagnosis and overtreatment may outweigh the benefits. Apparent benefits to patients with screen-detected cancers may be due to selection bias from exclusion of interval cancers (ICs). Treatment intensity is rarely discussed, with an assumption that all ESBCs are treated similarly. We hypothesized that women diagnosed while in a screening program would receive less-intense treatment than those never or not recently screened (NRS). Methods This was a retrospective analysis of all women aged 50–69 years managed for ESBC (invasive or DCIS) during the period 2007–2013 within a single service, comparing treatment according to screening status. Data on demographics, detection, pathology, and treatment were derived from hospital, cancer registry, and screening service records. Results Overall, 622 patients were active screeners (AS) at diagnosis (569 screen-detected and 53 ICs) and 169 patients were NRS. AS cancers were smaller (17 mm vs. 26 mm, p < 0.0001), less likely to involve nodes (26% vs. 48%, p < 0.0001), and lower grade. For invasive cancer, NRS patients were more likely to be recommended for mastectomies [35% vs. 16%; risk ratio(RR) 2.2, p < 0.0001], axillary dissection (43% vs. 19%; RR 2.3, p < 0.0001), adjuvant chemotherapy (65% vs. 37%; RR 1.7, p < 0.0001), and postmastectomy radiotherapy (58% vs. 39%; RR 1.5, p = 0.04). Conclusion Participants in population screening diagnosed with ESBC receive substantially less-intense treatment than non-participants. Differences persist when potential overdiagnosis is taken into account; these differences should be factored into debates around mammographic screening.
Division: Cancer Research Division
Funding Body: This project is partly funded through the Cancer Australia Priority-driven Collaborative Cancer Research Scheme (Nickson C, Canfell K, Barandregt J, Petrie D, Mann B, Brennan P. Maximising benefits and minimising harms in the BreastScreen program: a population health economics modelling approach. 2014–2016) and by research funds of the Royal Melbourne Hospital/Royal Women’s Hospital Breast Service.
DOI: 10.1245/s10434-018-6469-7
Appears in Collections:Research Articles

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