Performance measures among non-immigrants and immigrants attending BreastScreen Norway: a population-based screening programme
To explore performance measures among non-immigrants and immigrants attending BreastScreen Norway.
We analysed data from 2,951,375 screening examinations among non-immigrants and 153,026 among immigrants from 1996 to 2015. Immigrants were categorised into high- and low-incidence countries according to the incidence of breast cancer in their birth country. Performance measures, including attendance and recall rates, rates of screen-detected cancer (SDC) and interval breast cancer (IBC), positive predictive value (PPV) and histopathological tumour characteristics, were analysed. We used Fisher’s exact model and t tests for descriptive statistics, and Poisson regression, adjusting for age and screening history, comparing results for non-immigrants versus immigrants.
Attendance rates were 78% for non-immigrants and 56% for immigrants (p < 0.001). Rates of prevalent screens were 24% for non-immigrants and 32% for immigrants (p < 0.001). Immigrants from low-incidence countries were younger at diagnosis than non-immigrants (57 years versus 60 years, p < 0.001). Recall rates were 3.1% for non-immigrants and 3.8% for immigrants (p < 0.001), while PPVs were 17% and 14% (p < 0.001), respectively. IBCs in immigrants from low-incidence countries were more often triple negative (RRadj 1.81, 95% CI 1.11–2.94) than those in non-immigrants. Both SDC and IBC in immigrants from low-incidence countries tended more often to be histological grade 3 than those in non-immigrants.
Immigrants had lower attendance rates, higher recall rates and lower PPV than non-immigrants. The optimal age range and screening interval for immigrant women from low-incidence countries need to be further investigated.
• Immigrants from countries with a low incidence of breast cancer had their breast cancer diagnosed at a younger age than non-immigrants.
• Interval breast cancers detected in immigrants from countries with a low incidence of breast cancers were more often triple negative than those in non-immigrants.
• The optimal age range and screening interval for immigrant women from low-incidence countries and non-immigrants might differ.
KeywordsMammography Early detection of cancer Breast cancer Mass screening Health care utilisation
Ductal carcinoma in situ
Full-field digital mammography
Interval breast cancer
Invasive carcinoma of no special type
Invasive lobular carcinoma
We would like to thank the Norwegian Breast Cancer Society and the Norwegian ExtraFoundation for Health and Rehabilitation for their support. We would also like to thank Kaitlyn Tsuruda for the language editing.
This study was supported by a grant from the Norwegian Breast Cancer Society and received funding from the Norwegian ExtraFoundation for Health and Rehabilitation (2016/FO76429) (https://www.extrastiftelsen.no/logo/; English description towards the end).
Compliance with ethical standards
The scientific guarantor of this publication is Solveig Hofvind.
Conflict of interest
The authors declare that they have no conflict of interest.
Statistics and biometry
One of the authors has significant statistical expertise.
Written informed consent was waived by the institutional review board (the Regional Ethical Committee approved the use of the data for the study).
Institutional review board approval was obtained. This study has been approved by the Regional Committee for Medical and Health Research Ethics in South-eastern Norway, REC South East (2013/795).
Study subjects or cohorts overlap
This cohort is used in several studies from the Cancer Registry of Norway. However, this paper represents an original study which has not been performed previously.
• Cohort study (historic cohort)
• Performed at one institution
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