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Protection of mammography screening against death from breast cancer in women aged 40–64 years

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Abstract

Objective

This study assessed the efficacy of community-based screening mammography in protecting against breast cancer death, asking whether age differences in efficacy persisted in the 1990s.

Methods

In a case–control study with follow-up, odds ratios (OR) were used to estimate the relative mortality rates from invasive breast cancer among women with at least one screening mammogram in the two years prior to a baseline reference date compared to non-screened women, adjusting for potential confounding. The multicenter population-based study included 553 black and white women diagnosed during 1994–1998 who died in the following five years, and 4016 controls without breast cancer.

Results

Efficacy for reducing the rate of breast cancer death within five years after diagnosis was greater at ages 50–64 years (OR = 0.47, 95% confidence interval (CI) 0.35–0.63) than at ages 40–49 (OR = 0.89, 95% CI 0.65–1.23), and greater among postmenopausal (OR = 0.45, 95% CI 0.33–0.62) than premenopausal women (OR = 0.74, 95% CI 0.53–1.04). Estimates of efficacy were conservative, as shown by sensitivity analyses addressing whether cancer was discovered by a screening mammogram, age at which screening was received, the length of the screening observation window, and years of follow-up after diagnosis.

Conclusions

Despite the persistence of age differences in efficacy of mammography screening, with greater observed benefit for women aged 50–64 years, these findings support current screening recommendations for women 40–64 years old.

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Notes

  1. ORs and 95% CIs for late-stage disease differ slightly from those in Norman et al. [15] because 11 cases aged 40–49 years and eight cases aged 50–64 years with diagnosis of late-stage disease were added to the data set.

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Acknowledgments

This study was funded by the Centers for Disease Control and Prevention (CDC), Division of Cancer Prevention and Control, through subcontracts to the Women’s Contraceptive and Reproductive Experiences (CARE) Study through an interagency agreement with the National Institute of Child Health and Human Development (NICHD), and by CDC Division of Cancer Prevention and Control contract #200-2002-00370 with the University of Pennsylvania (Sandra A. Norman, P.I.). The Women’s CARE Study was funded by the NICHD, with additional support from the National Cancer Institute, through contracts with Emory University (N01-HD-3-3168), Fred Hutchinson Cancer Research Center (N01-HD-2-3166), Karmanos Cancer Institute at Wayne State University (N01-HD-3-3174), the University of Pennsylvania (N01-HD-3-3176) and the University of Southern California (N01-HD-3-3175) and through an interagency agreement with CDC (Y01-HD-7022). CDC also contributed additional staff and computer support. General support was also provided through Surveillance, Epidemiology and End Results Program contracts N01-PC-67006 (Atlanta), N01-CN-65064 (Detroit), N01-PC-67010 (Los Angeles), and N01-CN-0532 (Seattle). The authors thank Lars Holmberg, M.D., Ph.D. for his helpful advice and comments.

Author information

Author notes

  1. Lan Zhou

    Present address: Department of Statistics, Texas A&M University, College Station, TX, USA

  2. Linda K. Weiss

    Present address: National Cancer Institute, Cancer Centers Branch, Bethesda, MD, USA

Authors and Affiliations

  1. Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania, 801 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA

    Sandra A. Norman, A. Russell Localio, Anita L. Weber & Lan Zhou

  2. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Ralph J. Coates & Marion R. Nadel

  3. Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA

    Leslie Bernstein

  4. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Kathleen E. Malone

  5. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, GA, USA

    Polly A. Marchbanks

  6. Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, MI, USA

    Linda K. Weiss

  7. Private Consultant, Decatur, GA, USA

    Nancy C. Lee

Authors
  1. Sandra A. Norman
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Corresponding author

Correspondence to Sandra A. Norman.

Additional information

The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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Norman, S.A., Russell Localio, A., Weber, A.L. et al. Protection of mammography screening against death from breast cancer in women aged 40–64 years. Cancer Causes Control 18, 909–918 (2007). https://doi.org/10.1007/s10552-007-9006-8

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  • DOI: https://doi.org/10.1007/s10552-007-9006-8

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