Performance measures among non-immigrants and immigrants attending BreastScreen Norway: a population-based screening programme

  • Sameer Bhargava
  • Lars Andreas Akslen
  • Ida Rashida Khan Bukholm
  • Solveig HofvindEmail author



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.

Key Points

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.


Mammography Early detection of cancer Breast cancer Mass screening Health care utilisation 



Ductal carcinoma in situ


Oestrogen receptor


Full-field digital mammography


Interval breast cancer


Invasive carcinoma of no special type




Invasive lobular carcinoma


Progesterone receptor


Screen-detected cancer


Screen-film mammography



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) (; 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.

Informed consent

Written informed consent was waived by the institutional review board (the Regional Ethical Committee approved the use of the data for the study).

Ethical approval

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.


• prospective

• Cohort study (historic cohort)

• Performed at one institution

Supplementary material

330_2019_6009_MOESM1_ESM.docx (43 kb)
ESM 1 (DOCX 43 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.The Cancer Registry of NorwayOsloNorway
  2. 2.Institute of Health and Society, Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for PathologyUniversity of BergenBergenNorway
  4. 4.Department of PathologyHaukeland University HospitalBergenNorway
  5. 5.Norwegian System of Compensation to PatientsOsloNorway
  6. 6.Department of Landscape Architecture and Spatial Planning, Faculty of Social SciencesNorwegian University of Life SciencesOsloNorway
  7. 7.Department of Life Sciences and Health, Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway

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