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

European Radiology volume 29, pages 4833–4842 (2019)Cite this article

Abstract

Objectives

To explore performance measures among non-immigrants and immigrants attending BreastScreen Norway.

Methods

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.

Results

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.

Conclusion

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.

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Abbreviations

DCIS:

Ductal carcinoma in situ

ER:

Oestrogen receptor

FFDM:

Full-field digital mammography

IBC:

Interval breast cancer

ICNST:

Invasive carcinoma of no special type

IHC:

Immunohistochemistry

ILC:

Invasive lobular carcinoma

PR:

Progesterone receptor

SDC:

Screen-detected cancer

SFM:

Screen-film mammography

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Acknowledgements

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.

Funding

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).

Author information

Affiliations

  1. The Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304, Oslo, Norway

    Sameer Bhargava & Solveig Hofvind

  2. Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway

    Sameer Bhargava

  3. Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway

    Lars Andreas Akslen

  4. Department of Pathology, Haukeland University Hospital, Bergen, Norway

    Lars Andreas Akslen

  5. Norwegian System of Compensation to Patients, Oslo, Norway

    Ida Rashida Khan Bukholm

  6. Department of Landscape Architecture and Spatial Planning, Faculty of Social Sciences, Norwegian University of Life Sciences, Oslo, Norway

    Ida Rashida Khan Bukholm

  7. Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway

    Solveig Hofvind

Authors
  1. Sameer Bhargava
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  2. Lars Andreas Akslen
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  3. Ida Rashida Khan Bukholm
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  4. Solveig Hofvind
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Corresponding author

Correspondence to Solveig Hofvind.

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Guarantor

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.

Methodology

• prospective

• Cohort study (historic cohort)

• Performed at one institution

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Bhargava, S., Akslen, L.A., Bukholm, I.R.K. et al. Performance measures among non-immigrants and immigrants attending BreastScreen Norway: a population-based screening programme. Eur Radiol 29, 4833–4842 (2019). https://doi.org/10.1007/s00330-019-6009-2

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  • DOI: https://doi.org/10.1007/s00330-019-6009-2

Keywords

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