Does geographic location impact the survival differential between screen- and interval-detected breast cancers?
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Although mammography screening programs aim to diagnose breast cancer at an early stage, not all tumours are detected during the regular screening examination. This study examines the influence of various characteristics, including geographical residence, on the survival between screen- and interval-detected breast cancers among participants of a public population-based breast screening program in Queensland, Australia. The investigation was performed using the linked population-based datasets from BreastScreen Queensland and the Queensland Cancer Registry for the period of 1997–2008 for women aged 40–89 years at diagnosis. A Bayesian spatial relative survival modelling approach that accommodates rare outcomes in small geographic regions was adopted, with the use of Markov chain Monte Carlo computation, to evaluate the relative excess risk of breast cancer. In the multivariate Bayesian spatial model, higher relative excess risk of mortality was observed in interval-detected cancer (RER = 1.59, 95 % credible interval = [1.33, 1.89]) compared to screen-detected cancer. Higher cancer survival among the study cohort was also observed among younger women (40–59 years), those of non-Indigenous ethnicity, with localised (stage I) tumour stage as well as those not in the work force. There was no independent association with marital status. Moreover, there was no substantive evidence of either measured geographical or latent random spatial inequalities in survival among screening participants across Queensland, meaning the higher survival for screen-detected breast cancer patients compared to interval-detected women was consistent across the state. These results provide suggestive evidence supporting the effectiveness of the BreastScreen Queensland screening program in reaching socio-economically disadvantaged women as well as those living in rural and remote areas of the state, but also highlights the need for any interval cancer awareness programs to be geographically widespread.
KeywordsBayesian modelling Breast cancer Mammography screening Interval-detected Relative survival Spatial survival inequalities
This study was supported by an Australian Research Council (ARC) Linkage Project between Queensland University of Technology, Cancer Council Queensland and BreastScreen Queensland (LP100100570). Peter Baade is funded by a National Health and Medical Research (NHMRC) Career development Fellowship (Level 2) (1005334).
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