A case–control study to evaluate the impact of the breast screening programme on breast cancer incidence in England. (18th July 2022)

• Record Type: Journal Article
• Authors: Blyuss, Oleg; Dibden, Amanda; Massat, Nathalie J.; Parmar, Dharmishta; Cuzick, Jack; Duffy, Stephen W.; Sasieni, Peter
• Is Part Of: Cancer medicine. Volume 12:Number 2(2023)
• Page Start: 1878
• Page End: 1887
• Publication Date: 2022-07-18
• Subjects: breast cancer -- cancer prevention -- screening -- women's cancer; 616.994005
• DOI: 10.1002/cam4.5004
• Languages: English
• ISSNs: 2045-7634

Abstract

Abstract: 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. Abstract : We calculated estimates of relative risk of breast cancer diagnosis associated with screening exposure. We combined these with national incidence figures to obtain estimates of overdiagnosis associated with breast cancer screening. We found at worst modest levels of overdiagnosis as a result of the breast screening programme in England.