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Trends in stage-specific breast cancer incidence in New South Wales, Australia: insights into the effects of 25 years of screening mammography

  • Epidemiology
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Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Screening mammography aims to improve breast cancer (BC) prognosis by increasing the incidence of early-stage tumours in order to decrease the incidence of late-stage cancer, but no reports have investigated these potential effects in an Australian population. Therefore we aimed to identify temporal trends in stage-specific BC in New South Wales (NSW), Australia, between 1972 and 2012.

Methods

An observational study of women who received a diagnosis of BC from 1972–2012 as recorded in the NSW Cancer Registry, a population-based registry with almost complete coverage and high rates of histological verification. We analysed trends in stage-specific incidence before screening and compared them to periods after screening began. Our primary group of interest was women in the target age range of 50–69 years, though trends in women outside the target age were also assessed.

Results

Screening was not associated with lower incidence of late-stage BC at diagnosis. Incidence for all stages remained higher than prescreening levels. In women aged 50–69 years, the incidence of carcinoma in situ (CIS), localised and regional BC has more than doubled compared to the prescreening era, with incidence rate ratios ranging from 2.0 for regional (95% CI 1.95–2.13) to 121.8 for CIS (95% CI 82.58–179.72). Before the introduction of screening, there was a downward trend in distant metastatic BC incidence, and after the introduction of screening there was an increase (IRR 1.8; 95% CI 1.62–2.00). In women too young to screen the incidence of late-stage BC at diagnosis also increased, whereas localised disease was stable.

Conclusions

The incidence of all stages of BC has increased over the past 40 years, with the greatest rise seen during the established screening period for women aged 50–69 years. Our findings suggest that some of the expected benefits of screening may not have been realised and are consistent with overdiagnosis.

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Fig. 1

Note BreastScreen NSW offers biennial screening mammograms to women aged 40 years and older

Fig. 2
Fig. 3

Note Rates were standardised by 5-year age intervals within broad age groups, using the Australian 2001 population

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Abbreviations

BC:

Breast cancer

CIS:

Carcinoma in situ

HRT:

Hormone replacement therapy

IR:

Incidence rates

IRR:

Incidence rate ratios

IRD:

Incidence rate differences

MBS:

Medicare benefits schedule

NSW:

New South Wales

NSWCR:

New South Wales Cancer Registry

SNB:

Sentinel node biopsy

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Acknowledgements

This work was supported by grants from the National Health and Medical Research Centre, Australia. A postgraduate scholarship (Grant No 1074626) was awarded to GJ and a Centre for Research Excellence award (Grant No 1104136) was awarded to AB. Incidence data were supplied by the NSW Central Cancer Registry, which is managed and operated by The Cancer Council NSW under contract to the NSW Health Department.

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Authors and Affiliations

  1. Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia

    Kevin McGeechan, Les Irwig & Nehmat Houssami

  2. School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia

    Stephen Morrell

  3. Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia

    Gemma Jacklyn, Kevin McGeechan, Katy Bell & Alexandra Barratt

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  1. Gemma Jacklyn
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Correspondence to Gemma Jacklyn.

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All authors declare that they do not have any conflicts of interest to report.

Ethical approval

Our research protocol was approved by the research ethics board of the NSW Population & Health Services Research Ethics Committee (Cancer Institute NSW reference number: LNR 2014/07/032).

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Jacklyn, G., McGeechan, K., Irwig, L. et al. Trends in stage-specific breast cancer incidence in New South Wales, Australia: insights into the effects of 25 years of screening mammography. Breast Cancer Res Treat 166, 843–854 (2017). https://doi.org/10.1007/s10549-017-4443-x

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